Basic Information
| Provider Information | |||||||||
| NPI: | 1992175079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 OCEAN GTWY | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106908181 | ||||||||
| FaxNumber: | 4106908185 | ||||||||
| Practice Location | |||||||||
| Address1: | 8614 OCEAN GTWY | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106908181 | ||||||||
| FaxNumber: | 4106908185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2015 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LC2016 | MD | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.