Healthcare Provider Details

I. General information

NPI: 1912723651
Provider Name (Legal Business Name): DEONDRA LAVON THORNTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEONDRA LAVON HAMILTON LPC

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BEACON PKWY W STE 105
BIRMINGHAM AL
35209-3115
US

IV. Provider business mailing address

42 TREVOR DR
MILLBROOK AL
36054-3054
US

V. Phone/Fax

Practice location:
  • Phone: 205-775-6037
  • Fax:
Mailing address:
  • Phone: 334-322-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC06055
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: