Healthcare Provider Details

I. General information

NPI: 1548759699
Provider Name (Legal Business Name): DEREK TIMOTHY THOMAS LICDC-CS, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8116
  • Fax:
Mailing address:
  • Phone: 330-535-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162017
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: