Provider Demographics
NPI:1902246879
Name:THOMAS, JENNIFER KELLY SILCOX (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLY SILCOX
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 FORT SUMTER RD
Mailing Address - Street 2:#15A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2331
Mailing Address - Country:US
Mailing Address - Phone:423-676-8534
Mailing Address - Fax:
Practice Address - Street 1:4913 PROFESSIONAL CT
Practice Address - Street 2:SUITE 8
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4913
Practice Address - Country:US
Practice Address - Phone:919-277-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN971106H00000X
NC1528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist