Healthcare Provider Details

I. General information

NPI: 1841668506
Provider Name (Legal Business Name): CHARTRICE THORNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 MAYLAND DR SUITE 103
HENRICO VA
23294-4753
US

IV. Provider business mailing address

8527 MAYLAND DR SUITE 103
HENRICO VA
23294-4753
US

V. Phone/Fax

Practice location:
  • Phone: 804-363-2583
  • Fax: 804-510-0244
Mailing address:
  • Phone: 804-363-2583
  • Fax: 804-510-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008871
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0904008871
License Number StateVA

VIII. Authorized Official

Name: CHARTRICE THORNE
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 804-370-7819