Individual
MRS. BIANCA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
351 WAGONER DR STE 408, FAYETTEVILLE, NC 28303-4670
(910) 420-0267
Mailing address
351 WAGONER DR STE 408, FAYETTEVILLE, NC 28303-4670
(910) 420-0267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
15896
NC
101YM0800X
Mental Health Counselor
Primary
15896
NC
101YM0800X
Mental Health Counselor
A15896
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952919573
—
NC
Enumeration date
07/20/2020
Last updated
01/30/2025
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