Provider Demographics
NPI:1447686084
Name:THOMAS, SUJA MARY (M ED, LPC)
Entity type:Individual
Prefix:
First Name:SUJA
Middle Name:MARY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 ALAMEDA DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5093
Mailing Address - Country:US
Mailing Address - Phone:469-471-2433
Mailing Address - Fax:
Practice Address - Street 1:4100 FAIRWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6527
Practice Address - Country:US
Practice Address - Phone:972-221-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional