Provider Demographics
NPI:1780256982
Name:THOMAS, BETHANY SARA (LAPC, NCC, MS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:SARA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LAPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N POND WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2923
Mailing Address - Country:US
Mailing Address - Phone:770-833-7002
Mailing Address - Fax:
Practice Address - Street 1:1708 PEACHTREE ST NW STE 425
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7020
Practice Address - Country:US
Practice Address - Phone:770-569-3051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health