Basic Information
| Provider Information | |||||||||
| NPI: | 1467816967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | DIONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 AVE OF THE ACADIANS | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705708937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373157166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 WRIGHT AVE STE D | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705262226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375145181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | LA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.