Doctor Name: | DEBORAH ANN THIBEAULT |
NPI Number: | 1013226018 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 6290 |
Business Practice Address: | 325 N State Of Franklin Rd Johnson City, TN - 376046056 |
Business Phone Number: | 4234397320 |
Business Fax Number: | 4234397343 |
Mailing Address: | Po Box 699, MOUNTAIN HOME |
State: | TN |
Postal Code: | 376840699 |
Phone Number: | 4234336039 |
Fax Number: | 4234336060 |
NPI Enumeration Date: | 09/26/2010 |
NPI Last Update Date: | 11/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6290 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |