Provider Demographics
NPI:1649500323
Name:THOMAS, TACORA CAMILLE (MSW)
Entity type:Individual
Prefix:
First Name:TACORA CAMILLE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20611
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-3611
Mailing Address - Country:US
Mailing Address - Phone:818-853-2672
Mailing Address - Fax:
Practice Address - Street 1:400 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2339
Practice Address - Country:US
Practice Address - Phone:310-673-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW823341041C0700X
CAASW613291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical