Provider Demographics
NPI:1922245331
Name:THOMAS, DEMETRA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:ANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3279
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0879
Mailing Address - Country:US
Mailing Address - Phone:925-439-2770
Mailing Address - Fax:
Practice Address - Street 1:430 RAILROAD AVE STE 207
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2235
Practice Address - Country:US
Practice Address - Phone:925-439-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical