Provider Demographics
NPI:1942960224
Name:THOMAS, DANICA WAVNEY
Entity Type:Individual
Prefix:MS
First Name:DANICA
Middle Name:WAVNEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 FUNSTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5836
Mailing Address - Country:US
Mailing Address - Phone:954-588-8743
Mailing Address - Fax:
Practice Address - Street 1:3520 OAKS WAY APT 904
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5387
Practice Address - Country:US
Practice Address - Phone:305-807-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X, 103K00000X
FLJUDR16106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst