Provider Demographics
NPI:1548330814
Name:THOMAS, GENEVIEVE LAFAYE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:LAFAYE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 OLD RECEIVER RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2757
Mailing Address - Country:US
Mailing Address - Phone:208-241-3660
Mailing Address - Fax:
Practice Address - Street 1:199 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2704
Practice Address - Country:US
Practice Address - Phone:208-782-2060
Practice Address - Fax:208-782-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-277081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806855600Medicaid