Provider Demographics
NPI:1679977524
Name:MANUS, THOMAS JEFFERSON (LCADC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFERSON
Last Name:MANUS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EAST MAIN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5019
Mailing Address - Country:US
Mailing Address - Phone:410-857-8448
Mailing Address - Fax:410-857-0239
Practice Address - Street 1:77 EAST MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5019
Practice Address - Country:US
Practice Address - Phone:410-857-8448
Practice Address - Fax:410-857-0239
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA180101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor