MEDICARE: ANTHONY JOE THOMAS LCSW, MSW, M.DIV.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C002081	NC

General Provider Information

NPI Number	:	1053458133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JOE THOMAS LCSW, MSW, M.DIV.

Provider Business Mailing Address
First Line	:	809 SPRING FOREST RD
Second Line	:	SUITE 1000
City	:	RALEIGH
State	:	NC
Zip	:	27609-9700
Country	:	US
Telephone Number	:	919-850-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 SPRING FOREST RD
Second Line	:	SUITE 1000
City	:	RALEIGH
State	:	NC
Zip	:	27609-9700
Country	:	US
Telephone Number	:	919-850-9070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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