Provider Demographics
NPI:1104302322
Name:THOMAS, VERONICA NICHOLE (LLP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:NICHOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 W GRAND RIVER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2334
Mailing Address - Country:US
Mailing Address - Phone:734-707-7363
Mailing Address - Fax:
Practice Address - Street 1:748 W GRAND RIVER AVE STE B
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2334
Practice Address - Country:US
Practice Address - Phone:734-707-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015781103TC1900X
MI6361004068103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling