Provider Demographics
NPI:1194726968
Name:THYNE, KATHERINE CYNTHIA (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CYNTHIA
Last Name:THYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 KATHY LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4502
Mailing Address - Country:US
Mailing Address - Phone:770-634-9028
Mailing Address - Fax:877-283-9686
Practice Address - Street 1:3345 KATHY LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4502
Practice Address - Country:US
Practice Address - Phone:770-634-9028
Practice Address - Fax:877-283-9686
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0027001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA278677000OtherMAGELLAN ID NUMBER
GAGRP3412Medicare ID - Type UnspecifiedMEDICARE GROUP
GA278677000OtherMAGELLAN ID NUMBER
GAS81818Medicare UPIN