Provider Demographics
NPI:1245334945
Name:NOTO, THADDEUS LORENZO (MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:LORENZO
Last Name:NOTO
Suffix:
Gender:M
Credentials:MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EBONY LN
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2360
Mailing Address - Country:US
Mailing Address - Phone:423-477-6040
Mailing Address - Fax:
Practice Address - Street 1:6145 TEMPLE STAR RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-8028
Practice Address - Country:US
Practice Address - Phone:423-349-4070
Practice Address - Fax:423-349-6597
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional