Provider Demographics
NPI:1225536154
Name:THORNE, KRISTENE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTENE
Middle Name:MARIE
Last Name:THORNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 BOHON ST NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-3516
Mailing Address - Country:US
Mailing Address - Phone:540-986-4672
Mailing Address - Fax:540-776-0717
Practice Address - Street 1:3912 ELECTRIC RD BLDG C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4513
Practice Address - Country:US
Practice Address - Phone:540-986-4672
Practice Address - Fax:540-776-0717
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional