Provider Demographics
NPI:1982195764
Name:THOMAS, SERENA A (LSW)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:A
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:224 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1334
Mailing Address - Country:US
Mailing Address - Phone:740-592-6724
Mailing Address - Fax:740-592-6728
Practice Address - Street 1:12896 GREY ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9638
Practice Address - Country:US
Practice Address - Phone:740-380-6354
Practice Address - Fax:740-380-3592
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0500240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864002Medicaid
OH2314525Medicaid