Provider Demographics
NPI:1801094230
Name:THOMAS, REDONIA M (ACSW, LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:REDONIA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ACSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BROOKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-3997
Mailing Address - Country:US
Mailing Address - Phone:864-325-9282
Mailing Address - Fax:
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2210
Practice Address - Country:US
Practice Address - Phone:864-244-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical