Provider Demographics
NPI:1942575576
Name:THOMAS, DOUGLAS BART (MS, LPC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BART
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7610
Mailing Address - Country:US
Mailing Address - Phone:334-275-5405
Mailing Address - Fax:334-737-0192
Practice Address - Street 1:2408 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-7610
Practice Address - Country:US
Practice Address - Phone:334-275-5405
Practice Address - Fax:334-737-0192
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional