Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2004 | NC |
NPI | 1194982652 |
---|---|
Provider Name | Dawn Thomas |
First Address | Concord, NC 28025-4732 |
Second Address | Concord, NC 28025-4732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |