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General NPI Number Information
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NPI Number | 1457624868
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Entity Type | Individual
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Provider Name | CHARLETTE THOMAS THOMAS MS
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Gender | Female
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 315 NORTH LAKEMONT AVENUE, SUITE B BEHAVIORAL SUPPORT SERVICES
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-996-4905
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Fax |
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Provider Business Mailing Address
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Address Line | 315 NORTH LAKEMONT BEHAVIORAL SUPPORT SRVICES, INC
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-996-4905
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1673
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License Number State | FL
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