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1578045589 NPI number — TAMARA SMITH THOM MS LCMHC, LCAS

NPI Number: 1578045589
Health Care Provider/Practitioner: TAMARA SMITH THOM MS LCMHC, LCAS

Information about “1578045589” NPI (TAMARA SMITH THOM MS LCMHC, LCAS) exists in 1578045589 in HTML format HTML  |  1578045589 in plain Text format TXT  |  1578045589 in PDF (Portable Document Format) PDF  |  1578045589 in an XML format XML  formats.

NPI Number : 1578045589 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578045589",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THOM",
    "FirstName": "TAMARA",
    "MiddleName": "SMITH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS LCMHC, LCAS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMITH",
    "OtherFirstName": "TAMARA",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "MS, LCMHC, LCAS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2474 WALNUT ST STE 217",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARY",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27518-9212",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-849-8655",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2307 CUMBERLAND GAP DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28306-6940",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-849-8655",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/06/2018",
    "LastUpdateDate": "05/10/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "24268",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "13917",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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