Provider Demographics
NPI:1891166443
Name:THORNE, CHARTRICE
Entity Type:Individual
Prefix:
First Name:CHARTRICE
Middle Name:
Last Name:THORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 BOLELYN DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7264
Mailing Address - Country:US
Mailing Address - Phone:804-370-7819
Mailing Address - Fax:
Practice Address - Street 1:6955 BOLELYN DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-7264
Practice Address - Country:US
Practice Address - Phone:804-370-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040088711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical