Healthcare Provider Details

I. General information

NPI: 1891926010
Provider Name (Legal Business Name): THOMAS JAMES SNYDER LCAS #1458
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 BRONZE CIR
FOREST CITY NC
28043-5640
US

IV. Provider business mailing address

348 BRONZE CIR
FOREST CITY NC
28043-5640
US

V. Phone/Fax

Practice location:
  • Phone: 828-247-0074
  • Fax:
Mailing address:
  • Phone: 828-247-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS #1458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: