Healthcare Provider Details

I. General information

NPI: 1205660487
Provider Name (Legal Business Name): MAURICE THORNTON ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13854 CARTER HOUSE WAY
SILVER SPRING MD
20904-4855
US

IV. Provider business mailing address

5200 JAY ST NE
WASHINGTON DC
20019-5528
US

V. Phone/Fax

Practice location:
  • Phone: 301-346-5047
  • Fax:
Mailing address:
  • Phone: 202-378-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: