Licia Maria Thomas-Wagoner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904006772 Issued in VA

Practice address

9409 Hull Street Rd
Suite D1
North Chesterfield, VA 23236-1200

Phone

(804) 745-2225

Fax

(804) 745-2242

NPI assigned

Mar 24, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lewis Plastic Surgery, PC

  • Plastic Surgery Physician
  • Midlothian, VA
  • NPI 1386907400
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384214400000",
    "number": "1750553384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9409 HULL STREET RD",
            "address_2": "SUITE D1",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232361200",
            "telephone_number": "804-745-2225",
            "fax_number": "804-745-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9409 HULL STREET RD",
            "address_2": "SUITE D1",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232361200",
            "telephone_number": "804-745-2225",
            "fax_number": "804-745-2242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS-WAGONER",
        "first_name": "LICIA",
        "middle_name": "MARIA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-24",
        "last_updated": "2013-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945352",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine L Thekkekandam, M.D.
• Therapeutic Learning Consortium LLC
• Therapeutic Treatment Center
• Think Big Enterprises, LLC
• Thomas Johns Cancer Hospital at Johnston Willis Hospital
• Briana Thomas, MA
• Candace Joy Thomas, D.C.
• Caroline Thomas, LPC
• Christina Thomas, LPC
• Daron James Thomas

• Clinical Social Worker in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.