Provider Demographics
NPI:1619451127
Name:HERRIN, TIMOTHY LEE
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:HERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2244
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0038
Mailing Address - Country:US
Mailing Address - Phone:706-429-5493
Mailing Address - Fax:
Practice Address - Street 1:1387 HIGHTOWER CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-2208
Practice Address - Country:US
Practice Address - Phone:706-429-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health