Provider Demographics
NPI:1447941547
Name:THOMAS, LASTANGELA KRISCHINGO
Entity type:Individual
Prefix:
First Name:LASTANGELA
Middle Name:KRISCHINGO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3008
Mailing Address - Country:US
Mailing Address - Phone:601-748-2122
Mailing Address - Fax:
Practice Address - Street 1:510 E CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3008
Practice Address - Country:US
Practice Address - Phone:601-748-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical