Healthcare Provider Details

I. General information

NPI: 1821709205
Provider Name (Legal Business Name): TONY LEE THOMAS JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR BLDG 830
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

40 W 4TH ST APT 805
DAYTON OH
45402-1857
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-6877
  • Fax:
Mailing address:
  • Phone: 901-825-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12934
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9377
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9377
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: