Provider Demographics
NPI:1336847748
Name:BARRY, THEA HEDGLIN
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:HEDGLIN
Last Name:BARRY
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 1:105 BLAZING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0607
Mailing Address - Country:US
Mailing Address - Phone:706-951-8107
Mailing Address - Fax:
Practice Address - Street 1:105 BLAZING CREEK CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-0607
Practice Address - Country:US
Practice Address - Phone:706-951-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical