Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | AC1021 | MD |
NPI | 1003156522 |
---|---|
Provider Name | Bernice Thomas- El |
First Address | Lanham, MD 20706-4807 |
Second Address | Lanham, MD 20706-4807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 20/02/2013 |