Provider Demographics
NPI:1477269942
Name:THORNTON, GWENDOLYN B (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:B
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 WISTAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3646
Mailing Address - Country:US
Mailing Address - Phone:804-638-9122
Mailing Address - Fax:
Practice Address - Street 1:8051 WISTAR GLEN DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-3646
Practice Address - Country:US
Practice Address - Phone:804-638-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040011851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical