Provider Demographics
NPI:1164400297
Name:THORNBURG, ADRIAN B (MA, NCC, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:B
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 LEROY AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3316
Mailing Address - Country:US
Mailing Address - Phone:704-864-2496
Mailing Address - Fax:704-799-8949
Practice Address - Street 1:438 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3500
Practice Address - Country:US
Practice Address - Phone:980-430-9205
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3673101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional