Provider Demographics
NPI:1245373786
Name:STEVENS, THOMAS HENRY IV (LADC, LPC-A)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:STEVENS
Suffix:IV
Gender:M
Credentials:LADC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3648
Mailing Address - Country:US
Mailing Address - Phone:860-519-7802
Mailing Address - Fax:
Practice Address - Street 1:110 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4371
Practice Address - Country:US
Practice Address - Phone:860-657-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)