Provider Demographics
NPI:1528232626
Name:THOMAS, MARVIN CHILES (MA CACR NCGCI SWT)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:CHILES
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA CACR NCGCI SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 HENRIETTA
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-731-7081
Mailing Address - Fax:
Practice Address - Street 1:1943 HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-4169
Practice Address - Country:US
Practice Address - Phone:248-731-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803084972101YA0400X
MI6803044972101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral