Healthcare Provider Details

I. General information

NPI: 1366620387
Provider Name (Legal Business Name): LINDA L. NACE-THOMAS MS,LSW,PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W ELMWOOD DR SUITE 202
CENTERVILLE OH
45459-4239
US

IV. Provider business mailing address

77 W ELMWOOD DR SUITE 202
CENTERVILLE OH
45459-4239
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-0700
  • Fax: 937-424-5749
Mailing address:
  • Phone: 937-436-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0501378
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS24336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: