Provider Demographics
NPI:1861263535
Name:THOMAS, SEAN ALAN (BS, LMBT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ALAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:BS, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 ANGEL OAK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7852
Mailing Address - Country:US
Mailing Address - Phone:980-621-2324
Mailing Address - Fax:
Practice Address - Street 1:12709 ANGEL OAK DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7852
Practice Address - Country:US
Practice Address - Phone:980-621-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist