Provider Demographics
NPI:1891926010
Name:SNYDER, THOMAS JAMES (LCAS #1458)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LCAS #1458
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 BRONZE CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5640
Mailing Address - Country:US
Mailing Address - Phone:828-247-0074
Mailing Address - Fax:
Practice Address - Street 1:348 BRONZE CIR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-5640
Practice Address - Country:US
Practice Address - Phone:828-247-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS #1458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112173Medicaid