Individual
AJAH ASHANTI THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 SE MAIN ST STE 207, SIMPSONVILLE, SC 29681-2696
(864) 349-6390
(864) 676-9187
Mailing address
309 SE MAIN ST STE 207, SIMPSONVILLE, SC 29681-2696
(864) 458-8708
(864) 676-9187
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
SC
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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