Individual
MR. KENNETH HERBERT THOMAS JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CASAC, LPC
Contact information
Practice address
USA MEDDAC, 11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-4025
(315) 772-8801
Mailing address
106 RUGBY RD, SYRACUSE, NY 13206-3225
(315) 463-6297
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1234436
MI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
8778
NY
Other
Enumeration date
11/30/2005
Last updated
07/08/2007
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