Individual
DEBORAH ANN THIBEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
325 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6056
(423) 439-7320
(423) 439-7343
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 433-6039
(423) 433-6060
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6290
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3714470
GROUP MEDICARE
TN
05
—
6007677
—
NC
Enumeration date
09/26/2010
Last updated
11/02/2015
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