Provider Demographics
NPI:1144812314
Name:THOMAS, JEANETTA RUTH (LICSW)
Entity type:Individual
Prefix:
First Name:JEANETTA
Middle Name:RUTH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 KEELING RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-3827
Mailing Address - Country:US
Mailing Address - Phone:256-504-2501
Mailing Address - Fax:
Practice Address - Street 1:713 KEELING RD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-3827
Practice Address - Country:US
Practice Address - Phone:256-504-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4634C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4634COtherALABAMA STATE BOARD OF SOCIAL WORK EXAMINERS