Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 5419-C | NV |
NPI | 1003051509 |
---|---|
Provider Name | Dr. Heather Thanepohn |
First Address | Robins Afb, GA 31098-2227 |
Second Address | Robins Afb, GA 31098-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 14/08/2015 |