Provider Demographics
NPI:1952654295
Name:THOMAS, KIRK LAWRENCE SR
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:LAWRENCE
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LOWER MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-0785
Mailing Address - Country:US
Mailing Address - Phone:732-727-2555
Mailing Address - Fax:732-727-0255
Practice Address - Street 1:1 LOWER MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-0785
Practice Address - Country:US
Practice Address - Phone:732-727-2555
Practice Address - Fax:732-727-0255
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)