Healthcare Provider Details

I. General information

NPI: 1174507222
Provider Name (Legal Business Name): ELYN THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 ROSALIND AVE SW
ROANOKE VA
24014-1718
US

IV. Provider business mailing address

204 PINE DR
BLACKSBURG VA
24060-1809
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7653
  • Fax: 540-981-7469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904-005926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: