Provider Demographics
NPI:1952499675
Name:THOMAS, KERRY-LYNN SUZANNE (MED)
Entity Type:Individual
Prefix:MS
First Name:KERRY-LYNN
Middle Name:SUZANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ABINGDON CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3244
Mailing Address - Country:US
Mailing Address - Phone:919-771-9285
Mailing Address - Fax:
Practice Address - Street 1:1055 DRESSER CT
Practice Address - Street 2:BUILDING 2
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7323
Practice Address - Country:US
Practice Address - Phone:919-876-3130
Practice Address - Fax:919-876-3134
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5469101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5469OtherLPC LICENSE NUMBER