Healthcare Provider Details

I. General information

NPI: 1164400297
Provider Name (Legal Business Name): ADRIAN B. THORNBURG MA, NCC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E LONG AVE STE 1
GASTONIA NC
28054-3500
US

IV. Provider business mailing address

2321 LEROY AVE
GASTONIA NC
28054-3316
US

V. Phone/Fax

Practice location:
  • Phone: 980-430-9205
  • Fax: 704-799-8949
Mailing address:
  • Phone: 704-864-2496
  • Fax: 704-799-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3673
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3673
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: