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Individual
MS. TAMARA IDETTE THORN
Active
Individual
MS. TAMARA IDETTE THORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMSC DSW LCSW, PA-C
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NC
1041C0700X
Clinical Social Worker
8654
SC
1041C0700X
Clinical Social Worker
C004844
NC
1041C0700X
Clinical Social Worker
CSW004234
GA
363A00000X
Physician Assistant
Primary
5697
GA
363AM0700X
Medical Physician Assistant
5697
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-05760
PA
NC
01
—
5697
PA LICENSE
GA
05
—
6003179
—
NC
01
—
C004844
LCSW
NC
01
—
CSW004234
LCSW
GA
Enumeration date
12/09/2006
Last updated
06/22/2026
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