Provider Demographics
NPI:1013248319
Name:THOMAS, TOMORA (LSW)
Entity Type:Individual
Prefix:MS
First Name:TOMORA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WHITE STREET
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-249-4217
Mailing Address - Fax:601-249-4234
Practice Address - Street 1:1701 WHITE STREET
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-249-4217
Practice Address - Fax:601-249-4234
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLSW#W1010104100000X
MS104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker