Healthcare Provider Details

I. General information

NPI: 1073077962
Provider Name (Legal Business Name): WILLIAM A THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 SYLVANIA AVE.
TOLEDO OH
43613-4361
US

IV. Provider business mailing address

3965 HILLANDALE RD APT 4
OTTAWA HILLS OH
43606-2594
US

V. Phone/Fax

Practice location:
  • Phone: 419-450-8273
  • Fax:
Mailing address:
  • Phone: 419-349-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.166261
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: