Individual
SHAVONE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4955 S DURANGO DR STE 124, LAS VEGAS, NV 89113-1054
(702) 871-2273
Mailing address
1915 SIMMONS ST APT 2127, LAS VEGAS, NV 89106-1560
(702) 712-2593
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
N/A
NV
01
—
1234567
N/A
—
Enumeration date
05/08/2019
Last updated
09/07/2022
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