Individual
ELLEN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
304 PIERCE AVE, MACON, GA 31204-2422
(478) 464-3003
Mailing address
304 PIERCE AVE, MACON, GA 31204-2422
(478) 464-3003
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
AMFT000302
GA
106H00000X
Marriage & Family Therapist
Primary
MFT001400
GA
Other
Enumeration date
10/02/2014
Last updated
04/27/2015
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