1790753648 NPI number — MR. JAMES G THORNTON LPC

Table of content: MR. JAMES G THORNTON LPC (NPI 1790753648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790753648 NPI number — MR. JAMES G THORNTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
JAMES
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790753648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 POPLAR GROVE CONNECTOR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-5915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-264-8759
Provider Business Mailing Address Fax Number:
828-262-5687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 POPLAR GROVE CONNECTOR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-264-8759
Provider Business Practice Location Address Fax Number:
828-262-5687
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2707 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6103012 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: E0871 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2078793 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1016M . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 103877 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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