Provider Demographics
NPI:1538419452
Name:THOMAS, MAVIS B (LPC)
Entity type:Individual
Prefix:MS
First Name:MAVIS
Middle Name:B
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W BYPASS
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4731
Mailing Address - Country:US
Mailing Address - Phone:334-222-3555
Mailing Address - Fax:334-427-9522
Practice Address - Street 1:109 MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5364
Practice Address - Country:US
Practice Address - Phone:334-222-1818
Practice Address - Fax:334-222-1919
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional