=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801223532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN DENISE THOMAS THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2013
-----------------------------------------------------
Last Update Date | 09/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 LOUISIANA ST , SUITE 211
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72201-5712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-951-2629
-----------------------------------------------------
Fax | 501-325-0197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 523 LOUISIANA ST , SUITE 211
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72201-5712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-951-2629
-----------------------------------------------------
Fax | 501-325-0197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 329L
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------