Healthcare Provider Details

I. General information

NPI: 1700158664
Provider Name (Legal Business Name): DEBORAH HOOVER THOMAS LCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH VIRGINIA HOOVER MSW, LCSW, LCAC

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5873 DUNES HWY STE B2
PORTAGE IN
46368-1030
US

IV. Provider business mailing address

5075 PARK AVE
PORTAGE IN
46368-1117
US

V. Phone/Fax

Practice location:
  • Phone: 219-508-9935
  • Fax: 888-291-7776
Mailing address:
  • Phone: 219-508-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number340002639A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: