Individual
DERRICK D THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA, NREMT
Contact information
Practice address
21120 FULLER AVE, EUCLID, OH 44123-2710
(216) 432-8178
Mailing address
2738 ABBOTS COVE BLVD, COLUMBUS, OH 43204-4335
(216) 432-8178
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.172768
OH
146N00000X
Basic Emergency Medical Technician
156613
OH
373H00000X
Day Training/Habilitation Specialist
1828893
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000241617
—
OH
Enumeration date
11/19/2016
Last updated
02/04/2020
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