Provider Demographics
NPI:1790841740
Name:THOMAS, RICHARD S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 W WENDOVER AVE
Mailing Address - Street 2:SUITE-D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1580
Mailing Address - Country:US
Mailing Address - Phone:336-834-0616
Mailing Address - Fax:336-834-0411
Practice Address - Street 1:3409 W WENDOVER AVE
Practice Address - Street 2:SUITE-D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1580
Practice Address - Country:US
Practice Address - Phone:336-834-0616
Practice Address - Fax:336-834-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC416101YA0400X
NC534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional