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General NPI Number Information
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NPI Number | 1902567357
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Entity Type | Individual
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Provider Name | MICHAEL EVAN THOMAS LMFTA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 710 PETTIGRU ST
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City | GREENVILLE
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State | SC
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Zip | 29601-3121
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Country | US
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Telephone | 864-660-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 3419 OLD BUNCOMBE RD
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City | GREENVILLE
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State | SC
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Zip | 29617-7809
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 7327
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License Number State | SC
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