Provider Demographics
NPI:1184084113
Name:THOMAS, TROY NOLAN JR (RSW)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:NOLAN
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CONCORDIA PK
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3730
Mailing Address - Country:US
Mailing Address - Phone:601-870-5868
Mailing Address - Fax:
Practice Address - Street 1:4012 CARTER ST.
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373
Practice Address - Country:US
Practice Address - Phone:601-870-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health