Provider Demographics
NPI:1821537572
Name:THOMAS - GAY, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:THOMAS - GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4724 BELLE PLAINE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3412
Mailing Address - Country:US
Mailing Address - Phone:347-418-6049
Mailing Address - Fax:
Practice Address - Street 1:4921 ALBEMARLE RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6654
Practice Address - Country:US
Practice Address - Phone:980-819-6585
Practice Address - Fax:980-833-1426
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29792101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health