Provider Demographics
NPI:1023792660
Name:THORNANTE, KIRSTEN AMILOU (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:AMILOU
Last Name:THORNANTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:AMILOU
Other - Last Name:HAGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2474
Mailing Address - Country:US
Mailing Address - Phone:770-596-3376
Mailing Address - Fax:
Practice Address - Street 1:518 HOLLOW CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2474
Practice Address - Country:US
Practice Address - Phone:770-596-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0076361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical