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General NPI Number Information
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NPI Number | 1871061754
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Entity Type | Individual
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Provider Name | ANTAYSIA THOMAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 10908 COURTHOUSE RD STE 102149
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2658
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Country | US
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Telephone | 540-210-7624
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Fax | 833-520-1508
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Provider Business Mailing Address
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Address Line | 10908 COURTHOUSE RD STE 102149
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2658
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Country | US
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Telephone | 540-210-7624
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 31292
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010671
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License Number State | VA
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