Healthcare Provider Details

I. General information

NPI: 1124958905
Provider Name (Legal Business Name): RENEE GLENDA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 10TH ST
CRAMERTON NC
28032-1406
US

IV. Provider business mailing address

214 10TH ST
CRAMERTON NC
28032-1406
US

V. Phone/Fax

Practice location:
  • Phone: 980-505-6837
  • Fax:
Mailing address:
  • Phone: 980-505-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2026-11404-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: