Healthcare Provider Details

I. General information

NPI: 1619291663
Provider Name (Legal Business Name): THORNSBERRY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY SUITE 101-B
LEWES DE
19958-1772
US

IV. Provider business mailing address

750 KINGS HWY SUITE 101-B
LEWES DE
19958-1772
US

V. Phone/Fax

Practice location:
  • Phone: 302-858-2019
  • Fax: 302-644-6953
Mailing address:
  • Phone: 302-858-2019
  • Fax: 302-644-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberQ1-0000975
License Number StateDE

VIII. Authorized Official

Name: MR. MICHAEL JEROME THORNSBERRY
Title or Position: PRESIDENT
Credential: LCSW, CADC
Phone: 302-858-2019