Provider Demographics
NPI:1013338623
Name:THOMASSEN, DAVID GEORGE (MS, LGPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:THOMASSEN
Suffix:
Gender:M
Credentials:MS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5614
Mailing Address - Country:US
Mailing Address - Phone:240-578-2322
Mailing Address - Fax:
Practice Address - Street 1:309 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5614
Practice Address - Country:US
Practice Address - Phone:240-578-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health