Provider Demographics
NPI:1447455902
Name:THOMAS, JIMMIE LEE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW
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Other - Credentials:
Mailing Address - Street 1:8201 ROYAL SAND CIR
Mailing Address - Street 2:APT # 111
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1577
Mailing Address - Country:US
Mailing Address - Phone:813-476-7214
Mailing Address - Fax:
Practice Address - Street 1:8900 N ARMENIA AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1067
Practice Address - Country:US
Practice Address - Phone:813-228-2621
Practice Address - Fax:813-228-2868
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical