Provider Demographics
NPI:1841210705
Name:THOMAS, ALENA C (LCSW)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 S OCEAN DR
Mailing Address - Street 2:1102
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2142
Mailing Address - Country:US
Mailing Address - Phone:772-486-1498
Mailing Address - Fax:
Practice Address - Street 1:4590 SELVITZ RD
Practice Address - Street 2:BLDG B
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4801
Practice Address - Country:US
Practice Address - Phone:772-486-1498
Practice Address - Fax:772-595-3704
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059681041C0700X
FLSW 117351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8905786127Medicaid