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General NPI Number Information
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NPI Number | 1669508750
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Entity Type | Individual
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Provider Name | TIA THOMAS-RIVERS CSC-AD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6401 YORK RD, 3RD FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21212
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Country | US
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Telephone | 410-887-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 349 BRUAW DRIVE
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City | YORK
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State | PA
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Zip | 17406
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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 |
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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 | SC0906
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License Number State | MD
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