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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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