Provider Demographics
NPI:1831750611
Name:DE VITIS, THOMAS JR (MA, LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DE VITIS
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ATWATER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8782
Mailing Address - Country:US
Mailing Address - Phone:610-646-1851
Mailing Address - Fax:484-355-5181
Practice Address - Street 1:1200 ATWATER DR STE 130
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8782
Practice Address - Country:US
Practice Address - Phone:610-646-1851
Practice Address - Fax:484-355-5181
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
PAPC013103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)