Individual
CLARA THROCKMORTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1155 LAVISTA RD NE APT 2322, ATLANTA, GA 30324-3754
(734) 678-1363
Mailing address
5215 BRADMORE LN, WARREN, MI 48092-6322
(734) 678-1363
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801092793
MI
104100000X
Social Worker
Primary
6801112468
MI
1041C0700X
Clinical Social Worker
CSW007928
GA
Other
Enumeration date
03/02/2012
Last updated
01/06/2025
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