Provider Demographics
NPI:1841557717
Name:THOMAS, ANTOINETTE ALTHEA (LCPC, MAC,NCC,CTHP I)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ALTHEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCPC, MAC,NCC,CTHP I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 LOUNSBURY CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1840
Mailing Address - Country:US
Mailing Address - Phone:443-810-6944
Mailing Address - Fax:
Practice Address - Street 1:7102 LOUNSBURY CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1840
Practice Address - Country:US
Practice Address - Phone:443-810-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD641101YA0400X
MDLC4396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD462888495Medicaid