Provider Demographics
NPI:1124881552
Name:THOMAS, ANIA ETOSHA
Entity type:Individual
Prefix:MISS
First Name:ANIA
Middle Name:ETOSHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANIA
Other - Middle Name:ETOSHA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 MOUNT CROSS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5904
Mailing Address - Country:US
Mailing Address - Phone:434-228-7603
Mailing Address - Fax:
Practice Address - Street 1:708 MOUNT CROSS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5904
Practice Address - Country:US
Practice Address - Phone:434-228-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician