Provider Demographics
NPI:1477704138
Name:THOMSEN, GEORGIA ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:ANN
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 STATE ST S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6602
Mailing Address - Country:US
Mailing Address - Phone:425-468-9363
Mailing Address - Fax:
Practice Address - Street 1:608 STATE ST S
Practice Address - Street 2:SUITE 130
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6602
Practice Address - Country:US
Practice Address - Phone:425-468-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH10161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health