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General NPI Number Information
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NPI Number | 1578957858
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Entity Type | Organization
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Legal Business Name | C THOMAS ENTERPRISES LLC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 1913 PEMBRIDGE PL
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City | DETROIT
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State | MI
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Zip | 48207-3815
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Country | US
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Telephone | 313-506-8434
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7491
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City | DETROIT
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State | MI
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Zip | 48207-0491
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. CRYSTAL THOMAS
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Credential | LMSW CAADC
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Telephone | 313-506-8434
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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 | C-02865
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094273
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License Number State | MI
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