Healthcare Provider Details

I. General information

NPI: 1700776929
Provider Name (Legal Business Name): CHRISTOPHER ADAM THOMAS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PIEDMONT DR STE 2005
DANVILLE VA
24540-4175
US

IV. Provider business mailing address

11538 NC HIGHWAY 87 S
EDEN NC
27288-8164
US

V. Phone/Fax

Practice location:
  • Phone: 434-710-4210
  • Fax:
Mailing address:
  • Phone: 336-604-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24193989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: