Provider Demographics
NPI:1730510611
Name:THOMAS, ANGELA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:JASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1907 GARDEN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1965
Mailing Address - Country:US
Mailing Address - Phone:541-897-7703
Mailing Address - Fax:541-210-2848
Practice Address - Street 1:1907 GARDEN AVE STE 210
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1965
Practice Address - Country:US
Practice Address - Phone:541-897-7703
Practice Address - Fax:541-210-2848
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL71161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical