MEDICARE: ANTOINETTE ALTHEA THOMAS LCPC, MAC,NCC,CTHP I

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	641	MD
2	101YP2500X	Professional Counselor	LC4396	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

General Provider Information

NPI Number	:	1841557717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE ALTHEA THOMAS LCPC, MAC,NCC,CTHP I

Provider Business Mailing Address
First Line	:	7102 LOUNSBURY CT
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-1840
Country	:	US
Telephone Number	:	443-810-6944
Fax Number	:

Provider Business Practice Location Address
First Line	:	7102 LOUNSBURY CT
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-1840
Country	:	US
Telephone Number	:	443-810-6944
Fax Number	:

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

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	04/12/2021

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