Healthcare Provider Details

I. General information

NPI: 1740850619
Provider Name (Legal Business Name): STEPHANIE DELANE THOMAS CSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 LEE SCHOOL RD
SONORA KY
42776-9320
US

IV. Provider business mailing address

231 LEE SCHOOL RD
SONORA KY
42776-9320
US

V. Phone/Fax

Practice location:
  • Phone: 270-401-2095
  • Fax:
Mailing address:
  • Phone: 270-401-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255786
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: