Provider Demographics
NPI:1417634031
Name:THOMAS, THOMCY MARY (MA, LLPC)
Entity type:Individual
Prefix:
First Name:THOMCY MARY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BRETON CREEK CT SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9088
Mailing Address - Country:US
Mailing Address - Phone:269-873-3787
Mailing Address - Fax:
Practice Address - Street 1:781 KENMOOR AVE SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8624
Practice Address - Country:US
Practice Address - Phone:616-200-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health