Individual provider Active NPI

Thomas Henry Stevens IV, LADC, LPC-A

  • Addiction (Substance Use Disorder) Counselor
  • Glastonbury, CT
National Provider Identifier
1245373786
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
110 National Dr
Glastonbury, CT 06033-4371
Phone
(860) 657-8910
NPI assigned
Feb 15, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

110 National Dr
Glastonbury, CT 06033-4371

Mailing address

537 Prospect St
Wethersfield, CT 06109-3648
Phone (860) 519-7802

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240315002175 CT Practitioner - Mental Health Counselor 3678919305 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rushford Center, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Union Cognitive Care, PC Past Accepting new patients

Locations

883 Paddock Ave
Meriden, CT 06450
Phone (203) 630-5220

1250 Silver St
Middletown, CT 06457
Phone (860) 346-0300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1245373786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 PROSPECT ST",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061093648",
            "telephone_number": "860-519-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NATIONAL DR",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334371",
            "telephone_number": "860-657-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "THOMAS",
        "middle_name": "HENRY",
        "name_suffix": "IV",
        "credential": "LADC, LPC-A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

Verify at the official NPI Registry.