Provider Demographics
NPI:1821563412
Name:THOMASON, JENNIFER (MS, ALC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THOMASON
Suffix:
Gender:F
Credentials:MS, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11647 AL HIGHWAY 144
Mailing Address - Street 2:
Mailing Address - City:RAGLAND
Mailing Address - State:AL
Mailing Address - Zip Code:35131-4221
Mailing Address - Country:US
Mailing Address - Phone:205-753-3381
Mailing Address - Fax:
Practice Address - Street 1:11647 AL HIGHWAY 144
Practice Address - Street 2:
Practice Address - City:RAGLAND
Practice Address - State:AL
Practice Address - Zip Code:35131-4221
Practice Address - Country:US
Practice Address - Phone:205-753-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-18-64712106S00000X
ALALC04208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty