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General NPI Number Information
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NPI Number | 1245178987
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Entity Type | Individual
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Provider Name | TANISHA CHANTAE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 106 MASON ST
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City | BREWTON
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State | AL
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Zip | 36426-1536
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Country | US
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Telephone | 251-369-1466
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Fax |
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Provider Business Mailing Address
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Address Line | 421 LOREE RD
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City | EVERGREEN
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State | AL
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Zip | 36401-2114
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Country | US
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Telephone | 251-369-1796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | AL
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