Provider Demographics
NPI:1730850199
Name:THATIL, DIVYA R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIVYA
Middle Name:R
Last Name:THATIL
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 1:520 CLARIDGE WALK CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1861
Mailing Address - Country:US
Mailing Address - Phone:331-454-2874
Mailing Address - Fax:
Practice Address - Street 1:520 CLARIDGE WALK CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1861
Practice Address - Country:US
Practice Address - Phone:331-454-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical