Provider Demographics
NPI:1326286261
Name:WORRELL, THOMAS W (LCADC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:WORRELL
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 E ELMER ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4700
Mailing Address - Country:US
Mailing Address - Phone:856-692-4486
Mailing Address - Fax:856-692-5835
Practice Address - Street 1:733 E ELMER ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4700
Practice Address - Country:US
Practice Address - Phone:856-692-4486
Practice Address - Fax:856-692-5835
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00150100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)