Provider Demographics
NPI:1255564472
Name:THOMAS, ROXANN TRACY (QP,LCASA, MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROXANN
Middle Name:TRACY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:QP,LCASA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 SPINDLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8515
Mailing Address - Country:US
Mailing Address - Phone:704-297-6111
Mailing Address - Fax:
Practice Address - Street 1:5457 SPINDLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8515
Practice Address - Country:US
Practice Address - Phone:704-890-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27265101YA0400X
NCP0173921041C0700X, 261QM0850X
NCHC5684251E00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251E00000XAgenciesHome Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health