Healthcare Provider Details

I. General information

NPI: 1265355523
Provider Name (Legal Business Name): TERRANCE KENTRELL THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E CHOCCOLOCCO ST # O
OXFORD AL
36203-1222
US

IV. Provider business mailing address

1105 WALNUT ST
GADSDEN AL
35901-3934
US

V. Phone/Fax

Practice location:
  • Phone: 256-831-4601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: