Provider Demographics
NPI:1881965077
Name:THOMAS, SHERETTA DEION (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHERETTA
Middle Name:DEION
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHERETTA
Other - Middle Name:DEION
Other - Last Name:THOMAS-LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5300 W AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-8312
Mailing Address - Country:US
Mailing Address - Phone:661-940-4055
Mailing Address - Fax:661-940-4089
Practice Address - Street 1:5300 W AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-8312
Practice Address - Country:US
Practice Address - Phone:661-940-4055
Practice Address - Fax:661-940-4089
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251B00000X
CA27466104100000X
CA675871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management