Provider Demographics
NPI:1821642729
Name:THORNTON, CHARLES C (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:THORNTON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 WARTMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3238
Mailing Address - Country:US
Mailing Address - Phone:267-250-4269
Mailing Address - Fax:
Practice Address - Street 1:681 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2854
Practice Address - Country:US
Practice Address - Phone:267-933-5205
Practice Address - Fax:267-932-8660
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020433363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health