Provider Demographics
NPI:1851027023
Name:THOMAS, MIRACLE SHAREE
Entity Type:Individual
Prefix:
First Name:MIRACLE
Middle Name:SHAREE
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 1:1316 S MEADOW LN APT 187
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6415
Mailing Address - Country:US
Mailing Address - Phone:562-753-4717
Mailing Address - Fax:
Practice Address - Street 1:1316 S MEADOW LN APT 187
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6415
Practice Address - Country:US
Practice Address - Phone:562-753-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty