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General NPI Number Information
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NPI Number | 1679243034
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Entity Type | Individual
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Provider Name | JESSICA AUSTIN THOMAS MA, ED.S, LMHP-R
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 291 INDEPENDENCE BLVD STE 532
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5473
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Country | US
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Telephone | 757-962-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 1084 DEBACA CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6601
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Country | US
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Telephone | 757-619-5852
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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 | 0704013859
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License Number State | VA
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