Provider Demographics
NPI:1881852077
Name:BOCK, THOMAS WARREN (MA, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WARREN
Last Name:BOCK
Suffix:
Gender:M
Credentials:MA, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12208 FONTANA RUN APT 203
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4348
Mailing Address - Country:US
Mailing Address - Phone:804-229-4311
Mailing Address - Fax:804-272-6617
Practice Address - Street 1:12208 FONTANA RUN APT 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4348
Practice Address - Country:US
Practice Address - Phone:804-229-4311
Practice Address - Fax:804-272-6617
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2008-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102335101YA0400X
VA0701004372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)