Individual
JEROD MITCHELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
635 MAXWELTON CT, LEXINGTON, KY 40508-4012
(859) 252-1939
Mailing address
635 MAXWELTON CT, LEXINGTON, KY 40508-4012
(859) 252-1939
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
166725
KY
Other
Enumeration date
02/21/2019
Last updated
02/21/2019
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