Individual
THOMAS PATRICK BENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCADC, MS, MAC, SAP
Contact information
Practice address
8950 RTE 108, SUITE 235, COLUMBIA, MD 21045-2273
(443) 812-2758
Mailing address
8950 RTE 108, SUITE 235, COLUMBIA, MD 21045-2273
(443) 812-2758
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA157
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410405600
—
MD
01
—
LCA157
LICENSE
MD
Enumeration date
01/29/2007
Last updated
06/24/2009
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