Provider Demographics
NPI:1699806034
Name:THOMAS, RICHARD E (CAC-AD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CEDARMERE CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2446
Mailing Address - Country:US
Mailing Address - Phone:410-654-0486
Mailing Address - Fax:
Practice Address - Street 1:6401 YORK RD STE 3
Practice Address - Street 2:BALTIMORE CO. BUREAU OF SUBSTANCE ABUSE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2130
Practice Address - Country:US
Practice Address - Phone:410-853-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0796101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAC0796OtherCAC-AD