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General NPI Number Information
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NPI Number | 1912144833
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Entity Type | Individual
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Provider Name | ERIC C. THURMOND LPC
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Gender | Male
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 69 SEED TICK RD
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City | CLAYTON
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State | GA
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Zip | 30525-5988
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Country | US
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Telephone | 706-614-4786
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Fax | 855-945-3795
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Provider Business Mailing Address
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Address Line | 318 BLUE RIDGE GAP RD
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City | RABUN GAP
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State | GA
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Zip | 30568-2919
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Country | US
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Telephone | 706-614-4786
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Fax | 855-945-3795
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC005864
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License Number State | GA
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