Provider Demographics
NPI:1851734867
Name:THOMAS, KASHEENA M
Entity Type:Individual
Prefix:
First Name:KASHEENA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KASHEENA
Other - Middle Name:M
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 W HEALEY ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5025
Mailing Address - Country:US
Mailing Address - Phone:217-398-1658
Mailing Address - Fax:217-398-5177
Practice Address - Street 1:614 W HEALEY ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5025
Practice Address - Country:US
Practice Address - Phone:217-398-1658
Practice Address - Fax:217-398-5177
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor