Provider Demographics
NPI:1861650376
Name:THOMAS, PAMELA COLLIE (LCAS)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:COLLIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 ENSWORTH RD NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-2035
Mailing Address - Country:US
Mailing Address - Phone:252-291-7789
Mailing Address - Fax:252-291-7789
Practice Address - Street 1:101 BRENTWOOD CENTER LN N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1710
Practice Address - Country:US
Practice Address - Phone:252-291-7789
Practice Address - Fax:252-291-7789
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC851101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)