Provider Demographics
NPI:1851159396
Name:THALLHEIMER, ANGELIA
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:THALLHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 STALLINGS ST NW # 2832
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2351
Mailing Address - Country:US
Mailing Address - Phone:770-895-2978
Mailing Address - Fax:678-550-9431
Practice Address - Street 1:2131 STALLINGS ST NW # 2832
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2351
Practice Address - Country:US
Practice Address - Phone:770-895-2978
Practice Address - Fax:678-550-9431
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician