Basic Information
| Provider Information | |||||||||
| NPI: | 1558530170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FONSECA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6744 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701746744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043097844 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 3349 RIDGELAKE DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700023851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858566245 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3319 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 1107 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.