Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 00115429 | NY |
NPI | 1003245978 |
---|---|
Provider Name | Carlene Thomas |
First Address | Staten Island, NY 10302-1704 |
Second Address | Staten Island, NY 10302-1704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2013 |
Last Update Date | 01/11/2013 |