Provider Demographics
NPI:1073532685
Name:THOMAS, CARRIE CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:CHRISTINE
Last Name:THOMAS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 LITTLE SORREL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5486
Mailing Address - Country:US
Mailing Address - Phone:210-861-3940
Mailing Address - Fax:
Practice Address - Street 1:1273 LITTLE SORREL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5486
Practice Address - Country:US
Practice Address - Phone:210-861-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1738718-01Medicaid
TX648307OtherMEDICARE
TX8D5701Medicare ID - Type Unspecified