Provider Demographics
NPI:1447395231
Name:THACKER, GIANNA WUERL (LCSW)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:WUERL
Last Name:THACKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OVERLOOK CIR STE 102B
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5396
Mailing Address - Country:US
Mailing Address - Phone:678-907-4501
Mailing Address - Fax:
Practice Address - Street 1:212 OVERLOOK CIR STE 102B
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5396
Practice Address - Country:US
Practice Address - Phone:678-907-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000059081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA60054OtherAETNA
GA928870415AMedicaid
GA9344540OtherPHCS
GA80BBFTLMedicare ID - Type Unspecified