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General NPI Number Information
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NPI Number | 1871645788
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Entity Type | Individual
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Provider Name | DELORES THOMAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 1613 HARDY CASH DR
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City | HAMPTON
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State | VA
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Zip | 23666-2414
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Country | US
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Telephone | 757-595-2727
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Fax | 757-595-2776
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Provider Business Mailing Address
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Address Line | 1613 HARDY CASH DR
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City | HAMPTON
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State | VA
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Zip | 23666-2414
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Country | US
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Telephone | 757-595-2727
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Fax | 757-595-2776
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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 | 0904005125
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 0904005125
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License Number State | VA
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