Basic Information
| Provider Information | |||||||||
| NPI: | 1902481070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | REGINA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 INEICHEN ST STE A | ||||||||
| Address2: | |||||||||
| City: | RAYVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712693223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184177780 | ||||||||
| FaxNumber: | 3187281140 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 INEICHEN ST. STE. A | ||||||||
| Address2: | |||||||||
| City: | RAYVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712697126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184177780 | ||||||||
| FaxNumber: | 3187281140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2021 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10282 | LA | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.