Provider Demographics
NPI:1285132613
Name:THOMAS, CODI A (LISW)
Entity type:Individual
Prefix:
First Name:CODI
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-773-4750
Practice Address - Street 1:41865 POMEROY PIKE
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9473
Practice Address - Country:US
Practice Address - Phone:740-992-0540
Practice Address - Fax:740-773-4018
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1000814104100000X
OHI.2102722104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker