Provider Demographics
NPI:1316071962
Name:THOMAS, STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WHITE OAK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704
Mailing Address - Country:US
Mailing Address - Phone:479-502-4557
Mailing Address - Fax:844-222-4561
Practice Address - Street 1:2309 WHITE OAK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:479-530-2807
Practice Address - Fax:844-222-4561
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5896C101YM0800X, 1041C0700X
IL1490221961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health