Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LC4283 | MD |
NPI | 1356613392 |
---|---|
Provider Name | Jon Thomas |
First Address | Silver Spring, MD 20904-7277 |
Second Address | Columbia, MD 21045-5069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2012 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050795400 | (05) | MD |