Provider Demographics
NPI:1851839807
Name:THOMAS, STEPHEN (LICDC-CS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 JACKSON PIKE
Mailing Address - Street 2:P.O. BOX 88
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1398
Mailing Address - Country:US
Mailing Address - Phone:740-441-2924
Mailing Address - Fax:740-441-2970
Practice Address - Street 1:499 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1398
Practice Address - Country:US
Practice Address - Phone:740-441-2924
Practice Address - Fax:740-441-2970
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH954369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)