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General NPI Number Information
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NPI Number | 1700080801
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Entity Type | Individual
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Provider Name | THEA VONDRACEK LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 1931 NEW GARDEN RD STE 212
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City | GREENSBORO
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State | NC
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Zip | 27410-2556
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Country | US
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Telephone | 336-338-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 KOTCHS GROVE CT
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City | BROWNS SUMMIT
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State | NC
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Zip | 27214-9437
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Country | US
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Telephone | 336-295-3191
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1326
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License Number State | NC
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