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Individual

EDWARD ALFRED THIRY III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LSW, CAC

Contact information

Practice address
4845 W LAKE RD, SUITE 120, ERIE, PA 16505-2973
(814) 528-5323
Mailing address
4845 W LAKE RD, SUITE 120, ERIE, PA 16505-2973
(814) 528-5323

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5918
PA
104100000X
Social Worker
Primary
SW125058
PA

Other

Enumeration date
08/23/2010
Last updated
08/30/2010
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