Provider Demographics
NPI:1851286801
Name:THRELKELD, CARRIE LOUISE
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LOUISE
Last Name:THRELKELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:LOUISE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 RIVERSTONE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2566
Mailing Address - Country:US
Mailing Address - Phone:470-863-3090
Mailing Address - Fax:
Practice Address - Street 1:535 RIVERSTONE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2566
Practice Address - Country:US
Practice Address - Phone:470-863-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician