Healthcare Provider Details

I. General information

NPI: 1407769250
Provider Name (Legal Business Name): DWAYNE DEVEL THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E RANDOLPH RD STE A
HOPEWELL VA
23860-2745
US

IV. Provider business mailing address

201 E RANDOLPH RD STE A
HOPEWELL VA
23860-2745
US

V. Phone/Fax

Practice location:
  • Phone: 804-218-1300
  • Fax:
Mailing address:
  • Phone: 804-218-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: