Healthcare Provider Details

I. General information

NPI: 1336571058
Provider Name (Legal Business Name): SHARONDA C THOMAS M.ED, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARONDA CALDWELL M.ED

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 12/02/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD STE 312
SHREVEPORT LA
71104-3358
US

IV. Provider business mailing address

2620 CENTENARY BLVD STE 312
SHREVEPORT LA
71104-3358
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-9935
  • Fax: 318-681-9938
Mailing address:
  • Phone: 318-681-9935
  • Fax: 318-681-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: