MEDICARE: COURTNEY THOMAS LCSW

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	CSW009783	GA

General Provider Information

NPI Number	:	1336086834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY THOMAS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 675480
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-5480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE STE 100&200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	646-941-7645
Fax Number	:	929-596-7897

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

Provider Enumeration Date	:	05/01/2026
Last Update Date	:	05/01/2026

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