Provider Demographics
NPI:1811522642
Name:THOMAS, VICTORIA (MASTERS OF SCIENCE)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WRIGHT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2226
Mailing Address - Country:US
Mailing Address - Phone:337-514-5181
Mailing Address - Fax:337-514-5182
Practice Address - Street 1:1325 WRIGHT AVE STE D
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-514-5181
Practice Address - Fax:337-514-5182
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8044171M00000X
LA8044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator