Provider Demographics
NPI:1285732024
Name:THOMAS, BRANDI LACHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LACHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
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 93055
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-3055
Mailing Address - Country:US
Mailing Address - Phone:813-228-2761
Mailing Address - Fax:813-225-7048
Practice Address - Street 1:14517 BRUCE B DOWNS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2755
Practice Address - Country:US
Practice Address - Phone:813-228-2761
Practice Address - Fax:813-225-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1662C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical