1942938618 NPI number — MISS KIMBERLEY MICHELLE THORNBURG MA, LPC-A

Table of content: MISS KIMBERLEY MICHELLE THORNBURG MA, LPC-A (NPI 1942938618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942938618 NPI number — MISS KIMBERLEY MICHELLE THORNBURG MA, LPC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNBURG
Provider First Name:
KIMBERLEY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC-A
Provider Gender Code:
F

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:
1942938618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16515 WOOLWINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28278-8843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-855-8170
Provider Business Mailing Address Fax Number:
803-459-1550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHICK SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29609-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-434-4970
Provider Business Practice Location Address Fax Number:
866-813-6192
Provider Enumeration Date:
08/10/2022

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:  7497 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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