Individual
MRS. DEBORAH HOOVER THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC
Contact information
Practice address
5873 DUNES HWY STE B2, PORTAGE, IN 46368-1030
(219) 508-9935
(888) 291-7776
Mailing address
5075 PARK AVE, PORTAGE, IN 46368-1117
(219) 508-9935
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000651A
IN
1041C0700X
Clinical Social Worker
Primary
340002639A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
485380017
MEDICARE
IN
Enumeration date
02/07/2012
Last updated
03/30/2018
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