Provider Demographics
NPI:1669865176
Name:THOMAS, LORI J (LCSW, CADC, MISA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW, CADC, MISA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 NISH RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1552
Mailing Address - Country:US
Mailing Address - Phone:815-236-4832
Mailing Address - Fax:
Practice Address - Street 1:1711 NISH RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1552
Practice Address - Country:US
Practice Address - Phone:815-236-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13154101YA0400X
IL149-0100561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)