Healthcare Provider Details

I. General information

NPI: 1225757743
Provider Name (Legal Business Name): CARRIE LYNNETTE THORNTON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SOUTHAMPTON AVE
NORFOLK VA
23510-1021
US

IV. Provider business mailing address

850 SOUTHAMPTON AVE
NORFOLK VA
23510-1021
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4673
  • Fax: 757-668-8870
Mailing address:
  • Phone: 757-668-4673
  • Fax: 757-668-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810007930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: