Provider Demographics
NPI:1881217040
Name:THOMAS, RENARD DESJARION
Entity Type:Individual
Prefix:MR
First Name:RENARD
Middle Name:DESJARION
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BRADBURY WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1801
Mailing Address - Country:US
Mailing Address - Phone:254-213-8238
Mailing Address - Fax:
Practice Address - Street 1:33 BRADBURY WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1801
Practice Address - Country:US
Practice Address - Phone:254-213-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician