Provider Demographics
NPI:1033354212
Name:THRASHER, FREDRICK ANTONIA (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:ANTONIA
Last Name:THRASHER
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EAGLE SPRING DR STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6488
Mailing Address - Country:US
Mailing Address - Phone:678-565-1400
Mailing Address - Fax:866-945-9685
Practice Address - Street 1:110 EAGLE SPRING DR STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6488
Practice Address - Country:US
Practice Address - Phone:678-565-1400
Practice Address - Fax:866-945-9685
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA858969128AMedicaid