# MS. TAMARA IDETTE THORN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1548320823
- **Gender:** F
- **Credential:** DMSC DSW LCSW, PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | 5697 | GA | Yes |
| 363AM0700X | Medical Physician Assistant | 5697 | GA | — |

## Other

- **Enumeration date:** 12/09/2006
- **Last updated:** 06/22/2026

## 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 |