Individual
TEQUILLA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC-S, LICDC-CS
Contact information
Practice address
3454 OAK ALLEY CT, TOLEDO, OH 43606-1306
(734) 430-0980
Mailing address
PO BOX 3117, TOLEDO, OH 43607-0117
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0159337
—
OH
Enumeration date
02/10/2011
Last updated
07/09/2018
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