Provider Demographics
NPI:1164318788
Name:THOMAS, DESRINE (LDAC)
Entity type:Individual
Prefix:
First Name:DESRINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1161
Mailing Address - Country:US
Mailing Address - Phone:203-285-9243
Mailing Address - Fax:
Practice Address - Street 1:5 TIMBERLAND DR
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1161
Practice Address - Country:US
Practice Address - Phone:203-285-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)