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Individual

MS. TAMARA IDETTE THORN

Active
Sole proprietor
Yes

Provider details

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

Contact information

Practice address
635 STEPHENSON AVE, SAVANNAH, GA 31405-5970
(912) 352-2921
(912) 352-1038
Mailing address
PO BOX 2687, RICHMOND HILL, GA 31324-2687
(704) 898-7837
(912) 244-9958

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
1041C0700X
Clinical Social Worker
NC
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
12/17/2025
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