Healthcare Provider Details

I. General information

NPI: 1336963271
Provider Name (Legal Business Name): PRECIOUS THORNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18021 FAWN TREE DR
LITTLE ROCK AR
72210-7123
US

IV. Provider business mailing address

4813 RIDGE RD STE 111
DOUGLASVILLE GA
30134-6167
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-0376
  • Fax:
Mailing address:
  • Phone: 870-898-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number177288
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: