Provider Demographics
NPI:1487916334
Name:THOMAS, EMILY MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7682 LAINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7682 LAINGSBURG RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9306
Practice Address - Country:US
Practice Address - Phone:248-602-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2021-05-19
Deactivation Date:2018-02-27
Deactivation Code:
Reactivation Date:2018-03-06
Provider Licenses
StateLicense IDTaxonomies
MI68010943261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910402OtherBLUE CROSS