Healthcare Provider Details

I. General information

NPI: 1801615091
Provider Name (Legal Business Name): CHRISHAUNA R THOMAS LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 VIEWMONT DR
RALEIGH NC
27610-5331
US

IV. Provider business mailing address

4404 VIEWMONT DR
RALEIGH NC
27610-5331
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-7286
  • Fax:
Mailing address:
  • Phone: 919-622-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number009172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: