Healthcare Provider Details

I. General information

NPI: 1568555035
Provider Name (Legal Business Name): JOY COLLEEN MACTHOMAS LCSW, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOY COLLEEN THOMAS LCSW

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 ACADEMY AVE
DUBLIN GA
31021-5202
US

IV. Provider business mailing address

PO BOX 16549
DUBLIN GA
31040-6549
US

V. Phone/Fax

Practice location:
  • Phone: 478-697-4170
  • Fax:
Mailing address:
  • Phone: 478-274-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number507136
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: