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Organization
THOMAS A GONSALVES INCORPORATED
Active
Organization
THOMAS A GONSALVES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS ALLEN GONSALVES AM LCSW (PRESIDENT OF CORPORATION PRIVATE)
(601) 551-1327
Entity
Organization
Contact information
Practice address
307 APACHE DRIVE, SUITE B, MCCOMB, MS 39648-6309
(601) 551-1327
Mailing address
307 APACHE DRIVE, SUITE B, MCCOMB, MS 39648-6309
(601) 551-1327
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C5647
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01908563
—
MS
01
—
279761404A
BLUE CROSS BLUE SHIELD
MS
Enumeration date
06/07/2006
Last updated
10/19/2010
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