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General NPI Number Information
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NPI Number | 1245373786
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Entity Type | Individual
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Provider Name | THOMAS HENRY STEVENS IV LADC, LPC-A
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 110 NATIONAL DR
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City | GLASTONBURY
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State | CT
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Zip | 06033-4371
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Country | US
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Telephone | 860-657-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 537 PROSPECT ST
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City | WETHERSFIELD
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State | CT
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Zip | 06109-3648
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Country | US
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Telephone | 860-519-7802
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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 |
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License Number State |
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