Provider Demographics
NPI:1023743366
Name:THOMAS, ALLYSSA CHEA (RBT)
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:CHEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAWKSBILL DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-8090
Mailing Address - Country:US
Mailing Address - Phone:703-203-7581
Mailing Address - Fax:
Practice Address - Street 1:110 CAPCOM AVE STE 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6531
Practice Address - Country:US
Practice Address - Phone:919-594-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty