Provider Demographics
NPI:1013057298
Name:WARREN, THOMAS NATHANIEL (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NATHANIEL
Last Name:WARREN
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:3598 CARRIAGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8244
Mailing Address - Country:US
Mailing Address - Phone:252-937-8304
Mailing Address - Fax:252-937-5520
Practice Address - Street 1:852 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1706
Practice Address - Country:US
Practice Address - Phone:252-937-8304
Practice Address - Fax:252-937-5520
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional