Provider Demographics
NPI:1558418178
Name:THORN, PHILIP ANDREW (LCPC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:THORN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 MOUNT EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4264
Mailing Address - Country:US
Mailing Address - Phone:301-843-0004
Mailing Address - Fax:301-705-8753
Practice Address - Street 1:603 POST OFFICE RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:301-705-7593
Practice Address - Fax:301-705-8753
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0011101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional