Provider Demographics
NPI:1043361751
Name:THORNTON, PATRCIA ALICE (BA)
Entity Type:Individual
Prefix:MS
First Name:PATRCIA
Middle Name:ALICE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15058 BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2515
Mailing Address - Country:US
Mailing Address - Phone:760-780-6976
Mailing Address - Fax:
Practice Address - Street 1:14360 SAINT ANDREWS DR
Practice Address - Street 2:SUITE 11
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4341
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health