Provider Demographics
NPI:1396257697
Name:THOMAS, PAMELA (LCDC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 STEPHANY TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4066
Mailing Address - Country:US
Mailing Address - Phone:512-987-7863
Mailing Address - Fax:
Practice Address - Street 1:7706 STEPHANY TAYLOR DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4066
Practice Address - Country:US
Practice Address - Phone:512-363-2323
Practice Address - Fax:512-363-2323
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)