Provider Demographics
NPI:1366620387
Name:NACE-THOMAS, LINDA L (MS,LSW,PC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:NACE-THOMAS
Suffix:
Gender:F
Credentials:MS,LSW,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W ELMWOOD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4239
Mailing Address - Country:US
Mailing Address - Phone:937-436-0700
Mailing Address - Fax:
Practice Address - Street 1:77 W ELMWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4239
Practice Address - Country:US
Practice Address - Phone:937-436-0700
Practice Address - Fax:937-424-5749
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0501378101YP2500X
OHS24336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker