Individual
CHAUNNA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
500 EDGEWOOD RD STE 210, EDGEWOOD, MD 21040-2734
(443) 402-0172
Mailing address
500 EDGEWOOD RD STE 210, EDGEWOOD, MD 21040-2734
(443) 402-0172
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LC8470
MD
251S00000X
Community/Behavioral Health Agency
Primary
MH- 1044, MH-1043
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4210018
MEDICAID PROVIDER NUMBER
MD
Enumeration date
03/22/2012
Last updated
02/20/2018
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