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General NPI Number Information
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NPI Number | 1124318811
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Entity Type | Individual
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Provider Name | KENNETH N THOMAS MHS LCADC CAC DP LPC
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Gender | Male
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 3064 PENN ESTATES
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8696
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Country | US
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Telephone | 201-951-5596
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Fax |
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Provider Business Mailing Address
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Address Line | 930 N 9TH ST
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City | STROUDSBURG
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State | PA
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Zip | 18360-1208
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Country | US
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Telephone | 201-951-5596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | PC005579
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC005579
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00130200
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License Number State | NJ
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