Provider Demographics
NPI:1447082599
Name:THOMAS, LETICIA CLEMENTINA (LCSWA)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:CLEMENTINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRENNAN CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6426
Mailing Address - Country:US
Mailing Address - Phone:919-452-5648
Mailing Address - Fax:
Practice Address - Street 1:605 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1693
Practice Address - Country:US
Practice Address - Phone:919-283-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0204961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical