Individual
JACQUELIN RENEE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9307 MONROE RD STE P, CHARLOTTE, NC 28270-1486
(980) 420-3275
Mailing address
7210 JERIMOTH DR, CHARLOTTE, NC 28215-7447
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-30385
NC
101YM0800X
Mental Health Counselor
Primary
A22853
NC
Other
Enumeration date
05/08/2026
Last updated
05/08/2026
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