Provider Demographics
NPI:1942636956
Name:THOMAS, JACALYN WATSON (PHD, LCAS)
Entity Type:Individual
Prefix:DR
First Name:JACALYN
Middle Name:WATSON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD, LCAS
Other - Prefix:
Other - First Name:JACALYN
Other - Middle Name:GAYE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-0135
Mailing Address - Country:US
Mailing Address - Phone:252-572-2625
Mailing Address - Fax:252-572-2625
Practice Address - Street 1:510 DABNEY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3946
Practice Address - Country:US
Practice Address - Phone:252-572-2625
Practice Address - Fax:252-572-2955
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)