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General NPI Number Information
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NPI Number | 1477827830
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Entity Type | Individual
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Provider Name | CLARA THROCKMORTON
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Gender | Female
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1155 LAVISTA RD NE APT 2322
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City | ATLANTA
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State | GA
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Zip | 30324-3754
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Country | US
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Telephone | 734-678-1363
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Fax |
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Provider Business Mailing Address
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Address Line | 5215 BRADMORE LN
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City | WARREN
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State | MI
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Zip | 48092-6322
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Country | US
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Telephone | 734-678-1363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801092793
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW007928
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801112468
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License Number State | MI
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