Healthcare Provider Details

I. General information

NPI: 1881869972
Provider Name (Legal Business Name): ELAINE ANGELA THOMAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 LAWRENCE ST NE
MARIETTA GA
30060-2057
US

IV. Provider business mailing address

324 LAWRENCE ST NE
MARIETTA GA
30060-2057
US

V. Phone/Fax

Practice location:
  • Phone: 770-790-0773
  • Fax: 888-972-4898
Mailing address:
  • Phone: 770-790-0773
  • Fax: 888-972-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY002936
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY002936
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002936
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: