| Doctor Name: | MR. WILLIAM THOMAS MENTER |
| NPI Number: | 1003082405 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CCDC |
| License Number: | AC0166 |
| Business Practice Address: | 13114 Pennsylvania Ave Hagerstown, MD - 217422741 |
| Business Phone Number: | 2403133386 |
| Business Fax Number: | 2403133316 |
| Mailing Address: | 13114 Pennsylvania Ave, HAGERSTOWN |
| State: | MD |
| Postal Code: | 217422741 |
| Phone Number: | 2403133386 |
| Fax Number: | 2403133316 |
| NPI Enumeration Date: | 05/06/2008 |
| NPI Last Update Date: | 05/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | AC0166 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |