Provider Demographics
NPI:1740644749
Name:THOMAS, CHARLES (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4000 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1202
Mailing Address - Country:US
Mailing Address - Phone:713-359-3673
Mailing Address - Fax:713-359-1059
Practice Address - Street 1:1122 SOMERCOTES LN
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-2412
Practice Address - Country:US
Practice Address - Phone:281-352-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical