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Individual

MR. TRENT THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1607 MARTIN LUTHER KING JR DR, GREENSBORO, NC 27406-2423
(336) 965-7186
(888) 821-5068
Mailing address
PO BOX 36266, GREENSBORO, NC 27416-6266
(336) 965-7186
(888) 821-5068

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
175T00000X
Peer Specialist
Primary
2018-5019-01
NC
372500000X
Chore Provider
430176
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2018-5019-01
NCCPSS
NC
05
246915141O
NC
Enumeration date
03/17/2016
Last updated
06/11/2019
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