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General NPI Number Information
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NPI Number | 1396231403
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Entity Type | Individual
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Provider Name | DIANA THORNBERRY
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Gender | Female
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 664 SLATE AVE
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City | OWINGSVILLE
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State | KY
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Zip | 40360-2206
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Country | US
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Telephone | 606-233-1955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | ASHLAND
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State | KY
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Zip | 41105-0790
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Country | US
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Telephone | 606-329-8588
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Fax | 606-329-8195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 283235
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 271562
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License Number State | KY
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