Provider Demographics
NPI:1851745632
Name:THOMAS, VIRGINIA ELIZABETH (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:ELIZABETH
Other - Last Name:WALLINGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:725 WEST SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2053
Mailing Address - Country:US
Mailing Address - Phone:863-272-9636
Mailing Address - Fax:
Practice Address - Street 1:10014 NORTH DALE MABRY HIGHWAY SUITE C-100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:800-239-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000029351041C0700X
FLSW221541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical