Provider Demographics
NPI:1053933259
Name:THOMAS, LAURA ANN (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 EARL LAIN RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-6272
Mailing Address - Country:US
Mailing Address - Phone:912-250-9497
Mailing Address - Fax:
Practice Address - Street 1:1009 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-6828
Practice Address - Country:US
Practice Address - Phone:912-657-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013013101YP2500X
MTBBH-LCPC-LIC-42847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional