Provider Demographics
NPI:1497118525
Name:COLBERT, THOMAS FRANCIS SR (CSC-AD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:COLBERT
Suffix:SR
Gender:M
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 DILLE DR
Mailing Address - Street 2:PROGRAMS WEST
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9134
Mailing Address - Country:US
Mailing Address - Phone:301-780-2289
Mailing Address - Fax:
Practice Address - Street 1:13400 DILLE DR
Practice Address - Street 2:PROGRAMS WEST
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-9134
Practice Address - Country:US
Practice Address - Phone:301-780-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)