Provider Demographics
NPI:1033132568
Name:THOMAS, KENNETH C (LCPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRICO CORPORATION
Mailing Address - Street 2:P.O. BOX 826
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653
Mailing Address - Country:US
Mailing Address - Phone:301-862-4966
Mailing Address - Fax:301-862-5554
Practice Address - Street 1:SMALLWOOD BUILDING
Practice Address - Street 2:2670 CRAIN HIGHWAY, SUITE 525
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-632-2100
Practice Address - Fax:301-632-2150
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health