Provider Demographics
NPI:1770132094
Name:THOMSEN, NEITCHA RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NEITCHA
Middle Name:RUTH
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4769 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4816
Mailing Address - Country:US
Mailing Address - Phone:678-760-5502
Mailing Address - Fax:
Practice Address - Street 1:1200 ASHWOOD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-8024
Practice Address - Country:US
Practice Address - Phone:770-815-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0068441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical