Provider Demographics
NPI:1700158664
Name:THOMAS, DEBORAH HOOVER (LCSW, LCAC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:HOOVER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:VIRGINIA
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, LCAC
Mailing Address - Street 1:5075 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1117
Mailing Address - Country:US
Mailing Address - Phone:219-508-9935
Mailing Address - Fax:
Practice Address - Street 1:5873 DUNES HWY STE B2
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-1030
Practice Address - Country:US
Practice Address - Phone:219-508-9935
Practice Address - Fax:888-291-7776
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340002639A1041C0700X
IN87000651A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485380017OtherMEDICARE