| Thomas A Gonsalves Incorporated | |
|
307 Apache Drive Suite B Mccomb MS 39648-6309 | |
| (601) 551-1327 | |
| Not Available |
| Full Name | Thomas A Gonsalves Incorporated |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 307 Apache Drive, Mccomb, Mississippi |
| Authorized Official Name and Position | Thomas Allen Gonsalves (PRESIDENT OF CORPORATION PRIVATE) |
| Authorized Official Contact | 6015511327 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas A Gonsalves Incorporated 307 Apache Drive Suite B Mccomb MS 39648-6309 Ph: (601) 551-1327 | Thomas A Gonsalves Incorporated 307 Apache Drive Suite B Mccomb MS 39648-6309 Ph: (601) 551-1327 |
| NPI Number | 1659311967 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 10/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659311967 | NPI | - | NPPES |
| 279761404A | Other | MS | BLUE CROSS BLUE SHIELD |
| 01908563 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C5647 (Mississippi) | Primary |
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