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General NPI Number Information
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NPI Number | 1922448844
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Entity Type | Individual
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Provider Name | ASHLEY DOMINQUE THOMAS LCSW-S
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Gender | Female
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 1615 N MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77009-8525
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Country | US
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Telephone | 713-236-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 WOODLAND PARK DR APT K203
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City | HOUSTON
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State | TX
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Zip | 77077-3257
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Country | US
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Telephone | 734-474-0800
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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 | 6801093551
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License Number State | MI
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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 | 63477
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License Number State | TX
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