Provider Demographics
NPI:1821464249
Name:THOMAS, JAMAKA
Entity Type:Individual
Prefix:
First Name:JAMAKA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 WOODDALE BLVD
Mailing Address - Street 2:APT 13
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2928
Mailing Address - Country:US
Mailing Address - Phone:225-993-0263
Mailing Address - Fax:
Practice Address - Street 1:675 WOODDALE BLVD
Practice Address - Street 2:APT 13
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2928
Practice Address - Country:US
Practice Address - Phone:225-993-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional