Provider Demographics
NPI:1144299983
Name:EDMONDS, THOMAS BOMAR JR (BOMAR EDMONDS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BOMAR
Last Name:EDMONDS
Suffix:JR
Gender:M
Credentials:BOMAR EDMONDS
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:BOMAR
Other - Last Name:EDMONDS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:203 MANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1109
Mailing Address - Country:US
Mailing Address - Phone:864-579-0569
Mailing Address - Fax:
Practice Address - Street 1:203 MANSFIELD DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1109
Practice Address - Country:US
Practice Address - Phone:864-579-0569
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLISW CP 271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical