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General NPI Number Information
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NPI Number | 1841649381
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Entity Type | Individual
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Provider Name | ANGELA S THOMAS LADC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 421 E HICKORY ST SUITE 402
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City | MANKATO
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State | MN
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Zip | 56001-2635
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR ATTN: LINDA RANGEL
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 303332
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License Number State | MN
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