Healthcare Provider Details

I. General information

NPI: 1861532566
Provider Name (Legal Business Name): PATRICIA MILLER THORNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SEAFARER DR
ORIENTAL NC
28571-9651
US

IV. Provider business mailing address

1400 SEAFARER DR
ORIENTAL NC
28571-9651
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-5005
  • Fax:
Mailing address:
  • Phone: 434-392-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW0003615
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006723
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: