Provider Demographics
NPI:1932805413
Name:THOMAS, JOANNE D
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72327-2288
Mailing Address - Country:US
Mailing Address - Phone:309-648-3503
Mailing Address - Fax:
Practice Address - Street 1:190 THOMAS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72327-2288
Practice Address - Country:US
Practice Address - Phone:309-648-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009997101YP2500X
ARP2409001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional