Provider Demographics
NPI:1841791969
Name:THOMAS, MARIE LOUISE (LPCC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EDITH BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3524
Mailing Address - Country:US
Mailing Address - Phone:505-315-0042
Mailing Address - Fax:
Practice Address - Street 1:2221 RIO GRANDE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2529
Practice Address - Country:US
Practice Address - Phone:505-315-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0194901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional