Individual
ANTOINETTE M THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-S
Contact information
Practice address
1910 FAIRGROVE AVE STE E, HAMILTON, OH 45011-1930
(513) 795-7557
(513) 737-4603
Mailing address
8778 COTTONWOOD DR, CINCINNATI, OH 45231-4706
(513) 305-2218
(513) 737-4603
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I.1000009-SUPV
OH
1041C0700X
Clinical Social Worker
I.1000009-SUPV
OH
Other
Enumeration date
07/12/2013
Last updated
11/01/2022
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