Provider Demographics
NPI:1790525459
Name:THATCHER, WINONA GRACE (RBT)
Entity type:Individual
Prefix:
First Name:WINONA
Middle Name:GRACE
Last Name:THATCHER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BEXLEY SQ APT 343
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37410-3423
Mailing Address - Country:US
Mailing Address - Phone:615-828-2286
Mailing Address - Fax:
Practice Address - Street 1:177 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3838
Practice Address - Country:US
Practice Address - Phone:855-986-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB1130550106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician