Provider Demographics
NPI:1063679892
Name:THORNE, REN A (LCSW)
Entity Type:Individual
Prefix:
First Name:REN
Middle Name:A
Last Name:THORNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SUNCHASE BLVD
Mailing Address - Street 2:APT C
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2898
Mailing Address - Country:US
Mailing Address - Phone:434-391-7136
Mailing Address - Fax:
Practice Address - Street 1:407 SUNCHASE BLVD
Practice Address - Street 2:APT C
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2898
Practice Address - Country:US
Practice Address - Phone:434-391-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical