Provider Demographics
NPI:1912206756
Name:THOMAS, ELISA MARGARET (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:MARGARET
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 LONG BEACH RD SE STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8712
Mailing Address - Country:US
Mailing Address - Phone:910-880-3080
Mailing Address - Fax:
Practice Address - Street 1:1571 BRUSHWOOD CT SE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8189
Practice Address - Country:US
Practice Address - Phone:910-880-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10344101YM0800X, 106H00000X
NC1738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health