Provider Demographics
NPI:1023894805
Name:THOMAS, DAPHNE CARRIE (LCSW)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:CARRIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6671
Mailing Address - Country:US
Mailing Address - Phone:951-236-5042
Mailing Address - Fax:
Practice Address - Street 1:1802 MASTERS DR
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6671
Practice Address - Country:US
Practice Address - Phone:951-236-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical