Provider Demographics
NPI:1831426501
Name:THOMAS, GENEVIEVE (LPCA)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SARTIN DR
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8170
Mailing Address - Country:US
Mailing Address - Phone:270-432-4951
Mailing Address - Fax:270-432-5054
Practice Address - Street 1:112 SARTIN DR
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8170
Practice Address - Country:US
Practice Address - Phone:270-432-4951
Practice Address - Fax:270-432-5054
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid