MEDICARE: LE'KELDRIC THOMAS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1114233111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LE'KELDRIC THOMAS

Provider Business Mailing Address
First Line	:	300 COLONIAL CENTER PKWY STE 100N
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 COLONIAL CENTER PKWY STE 100N
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:	678-405-9363
Fax Number	:

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

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	01/18/2023

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Directions to “ LE'KELDRIC THOMAS ” Practice Location

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