Healthcare Provider Details

I. General information

NPI: 1043924723
Provider Name (Legal Business Name): CONNOR BARNES THORNTON-TYPHAIR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 GATEWAY BLVD
GROVETOWN GA
30813-3389
US

IV. Provider business mailing address

4039 GATEWAY BLVD
GROVETOWN GA
30813-3389
US

V. Phone/Fax

Practice location:
  • Phone: 706-498-9570
  • Fax: 678-369-5762
Mailing address:
  • Phone: 706-498-9570
  • Fax: 678-369-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: