Healthcare Provider Details

I. General information

NPI: 1053005272
Provider Name (Legal Business Name): KARLEY MADISON THORNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 BIRKDALE CROSSING DR STE 300
HUNTERSVILLE NC
28078-8459
US

IV. Provider business mailing address

5016 EVANDERS WAY APT 307
CHARLOTTE NC
28216-1293
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax:
Mailing address:
  • Phone: 910-305-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019453
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: