Provider Demographics
NPI:1831696145
Name:THOMAS, SHARISKE D (LMSW)
Entity type:Individual
Prefix:
First Name:SHARISKE
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DEERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-5307
Mailing Address - Country:US
Mailing Address - Phone:912-532-6876
Mailing Address - Fax:
Practice Address - Street 1:432 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2510
Practice Address - Country:US
Practice Address - Phone:912-349-2969
Practice Address - Fax:912-349-2983
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006784104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW006784OtherSTATE OF GEORGIA