Provider Demographics
NPI:1518298140
Name:THIESSEN, ERICA (LPC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:THIESSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 FILE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-3023
Mailing Address - Country:US
Mailing Address - Phone:706-212-2037
Mailing Address - Fax:801-437-2984
Practice Address - Street 1:236 FILE ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-3023
Practice Address - Country:US
Practice Address - Phone:706-212-2037
Practice Address - Fax:801-437-2984
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional