Individual
KENNETH THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
7 RIO SAN JOSE, LAGUNA, NM 87026
(505) 401-8369
Mailing address
7 RIO SAN JOSE, LAGUNA, NM 87026
(505) 401-8369
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3658
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3658
NEW MEXICO BEHAVIORAL HEALTH
NM
Enumeration date
10/09/2019
Last updated
10/09/2019
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