Provider Demographics
NPI:1134963739
Name:THOMAS, WILLIE
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 SW BARBUR BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5412
Mailing Address - Country:US
Mailing Address - Phone:971-429-2113
Mailing Address - Fax:
Practice Address - Street 1:9570 SW BARBUR BLVD STE 214
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5412
Practice Address - Country:US
Practice Address - Phone:971-429-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker