Provider Demographics
NPI:1124318811
Name:THOMAS, KENNETH N (MHS LCADC CAC DP LPC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:N
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MHS LCADC CAC DP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1208
Mailing Address - Country:US
Mailing Address - Phone:201-951-5596
Mailing Address - Fax:
Practice Address - Street 1:3064 PENN ESTATES
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8696
Practice Address - Country:US
Practice Address - Phone:201-951-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005579101YA0400X, 101YP2500X
NJ37LC00130200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional