Provider Demographics
NPI:1588895049
Name:LITWICKI, THOMAS MICHAEL (MED LISAC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:LITWICKI
Suffix:
Gender:M
Credentials:MED LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16361
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-6361
Mailing Address - Country:US
Mailing Address - Phone:520-977-3201
Mailing Address - Fax:520-762-1940
Practice Address - Street 1:7493 N ORACLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6343
Practice Address - Country:US
Practice Address - Phone:520-977-3201
Practice Address - Fax:520-762-1940
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 1100101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor