Provider Demographics
NPI:1710050919
Name:SCHENK, CONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:SCHENK
Suffix:
Gender:F
Credentials:PHD
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 1403
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1403
Mailing Address - Country:US
Mailing Address - Phone:229-228-1950
Mailing Address - Fax:229-228-1978
Practice Address - Street 1:1213 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4748
Practice Address - Country:US
Practice Address - Phone:229-228-1950
Practice Address - Fax:229-228-1978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002406103TF0200X, 103TC0700X
FLPY5933103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical