MEDICARE: THOMAS PATRICK BENNER LCADC, MS, MAC, SAP

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	LCA157	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	LCA157	OTHER	MD	LICENSE

General Provider Information

NPI Number	:	1770629578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS PATRICK BENNER LCADC, MS, MAC, SAP

Provider Business Mailing Address
First Line	:	8950 RTE 108
Second Line	:	SUITE 235
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2273
Country	:	US
Telephone Number	:	443-812-2758
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 RTE 108
Second Line	:	SUITE 235
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2273
Country	:	US
Telephone Number	:	443-812-2758
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	06/24/2009

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