Provider Demographics
NPI:1316106313
Name:THOMAS, CHARLES (MED, LPC, LCAS, CS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MED, LPC, LCAS, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 CELANDINE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-9265
Mailing Address - Country:US
Mailing Address - Phone:704-509-6787
Mailing Address - Fax:
Practice Address - Street 1:11400 CELANDINE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-9265
Practice Address - Country:US
Practice Address - Phone:704-509-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4447101YM0800X
NC1311101YA0400X
NCS7046101YM0800X
NC533101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104116Medicaid
NC6104116Medicaid
MA$$$$$$$$$THOMMedicaid