Individual
TRAVIS L THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 577-5011
Mailing address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 577-5011
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
9753
SC
1041C0700X
Clinical Social Worker
Primary
118535
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760596480
—
SC
Enumeration date
09/02/2009
Last updated
04/21/2016
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