Individual
DR. THOMAS RAY THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
222 COURTHOUSE CT, 2D, TOWSON, MD 21204-1828
(443) 692-7362
Mailing address
3328 GARRISON CIR, ABINGDON, MD 21009-2546
(443) 504-5631
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
05432
MD
Other
Enumeration date
06/07/2014
Last updated
06/07/2014
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