Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4208 | NC |
Y | 103T00000X | Psychologist | 4208 | NC |
NPI | 1003187410 |
---|---|
Provider Name | Jennifer Thomas |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28211-1082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2012 |
Last Update Date | 27/09/2021 |