Doctor Name: | MR. LEE DAVIS THOMAS |
NPI Number: | 1164743811 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. Q.P. |
License Number: | |
Business Practice Address: | 5228 Nc Hwy 211 West End, NC - 27376 |
Business Phone Number: | 9106738513 |
Business Fax Number: | 9106738521 |
Mailing Address: | 5228 Nc Hwy 211, WEST END |
State: | NC |
Postal Code: | 27376 |
Phone Number: | 9106738513 |
Fax Number: | 9106738521 |
NPI Enumeration Date: | 06/17/2010 |
NPI Last Update Date: | 06/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |