Provider Demographics
NPI:1356668693
Name:ANDERSON, THOMAS D (LCSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E TRINITY PL
Mailing Address - Street 2:PATHWAYS TRANSITIONS PROGRAMS, INC.
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3302
Mailing Address - Country:US
Mailing Address - Phone:678-576-2414
Mailing Address - Fax:770-521-7615
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:PATHWAYS TRANSITIONS PROGRAMS, INC.
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:678-576-2414
Practice Address - Fax:770-521-7615
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical