Provider Demographics
NPI:1730585589
Name:THOMAS, NAKIA SHANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:NAKIA
Middle Name:SHANA
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 1:4813 BRAMBLE WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2806
Mailing Address - Country:US
Mailing Address - Phone:318-207-0267
Mailing Address - Fax:844-871-2020
Practice Address - Street 1:4813 BRAMBLE WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2806
Practice Address - Country:US
Practice Address - Phone:318-207-0267
Practice Address - Fax:844-871-2020
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9568104100000X
LAAN5261851041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool