MEDICARE: ANTOINETTE THORNTON CEO, BSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	171M00000X	Case Manager/Care Coordinator
5	104100000X	Social Worker

General Provider Information

NPI Number	:	1932712858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE THORNTON CEO, BSW

Provider Business Mailing Address
First Line	:	2261 MILTON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3320
Country	:	US
Telephone Number	:	704-890-0666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2261 MILTON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3320
Country	:	US
Telephone Number	:	704-890-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	08/29/2020

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