Provider Demographics
NPI:1295807295
Name:THOMAS, RODNEY DONNELL (BA, MHPP)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:DONNELL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, MHPP
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:4354 STOCKTON DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2917
Practice Address - Country:US
Practice Address - Phone:501-955-7600
Practice Address - Fax:501-955-7612
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator