Individual
SHELISSA F THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDC1
Contact information
Practice address
542 4TH AVE STE B101, FAIRBANKS, AK 99701
(907) 374-1097
(907) 457-2196
Mailing address
PO BOX 82321, FAIRBANKS, AK 99708-2321
(907) 457-2176
(907) 457-2196
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3185
AK
171M00000X
Case Manager/Care Coordinator
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251C00000X
CARE COORDINATOR ADMINISTRATOR
AK
05
—
251C00000X
—
AK
01
—
3185
ADDICTION COUNSELOR
AK
Enumeration date
09/15/2009
Last updated
03/06/2020
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