Provider Demographics
NPI:1053875062
Name:THOMAS, JAMES III (ALC NCC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:ALC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-2142
Mailing Address - Country:US
Mailing Address - Phone:334-874-7785
Mailing Address - Fax:
Practice Address - Street 1:10096 AL HIGHWAY 14 W
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-1657
Practice Address - Country:US
Practice Address - Phone:334-874-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health