Provider Demographics
NPI:1962857706
Name:MACEWICZ, THOMAS GREGORY (MA, CRC, LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GREGORY
Last Name:MACEWICZ
Suffix:
Gender:M
Credentials:MA, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 N SWAN RD STE 250
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4053
Mailing Address - Country:US
Mailing Address - Phone:520-398-4265
Mailing Address - Fax:
Practice Address - Street 1:1661 N SWAN RD STE 250
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4053
Practice Address - Country:US
Practice Address - Phone:520-398-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional