Provider Demographics
NPI:1447476437
Name:TORBAHN, KONNIE A (PHD)
Entity type:Individual
Prefix:DR
First Name:KONNIE
Middle Name:A
Last Name:TORBAHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PLANTERS DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5180
Mailing Address - Country:US
Mailing Address - Phone:770-381-8001
Mailing Address - Fax:
Practice Address - Street 1:73 PLANTERS DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5180
Practice Address - Country:US
Practice Address - Phone:770-381-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical