Provider Demographics
NPI:1164159190
Name:TSCHIRHART, KATRINA ACACIA
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ACACIA
Last Name:TSCHIRHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 FERN VALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5672
Mailing Address - Country:US
Mailing Address - Phone:404-772-9081
Mailing Address - Fax:
Practice Address - Street 1:1519 JOHNSON FERRY RD BLDG 10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6409
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician