MEDICARE: DR. JOHN C THOMAS PH.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0776	VA
2	101YP2500X	Professional Counselor	2022	VA

General Provider Information

NPI Number	:	1235322272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C THOMAS PH.D., PH.D.

Provider Business Mailing Address
First Line	:	201 MULLBURY PL
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-5822
Country	:	US
Telephone Number	:	434-592-4047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1971 UNIVERSITY BLVD
Second Line	:	CENTER FOR COUNSELING AND FAMILY STUDIES, SUITE 2400 CN
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2269
Country	:	US
Telephone Number	:	434-592-4047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/23/2007

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