Provider Demographics
NPI:1063275873
Name:THOMAS, LISA (LPCMH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WILLOWTREE LN
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1752
Mailing Address - Country:US
Mailing Address - Phone:443-735-2013
Mailing Address - Fax:
Practice Address - Street 1:900 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5786
Practice Address - Country:US
Practice Address - Phone:302-262-3505
Practice Address - Fax:302-262-3507
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health