Provider Demographics
NPI:1215652722
Name:THACKER, PAULA D
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:THACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WOODCROFT PKWY APT 3003
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8290
Mailing Address - Country:US
Mailing Address - Phone:919-724-0825
Mailing Address - Fax:
Practice Address - Street 1:2719 NEUSE BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2857
Practice Address - Country:US
Practice Address - Phone:252-514-9888
Practice Address - Fax:252-514-2881
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0178311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical