Provider Demographics
NPI:1942716238
Name:SILVERTHORNE, DORIS
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:SILVERTHORNE
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 1:6016 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6329
Mailing Address - Country:US
Mailing Address - Phone:336-266-6139
Mailing Address - Fax:
Practice Address - Street 1:4401 PROVIDENCE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3226
Practice Address - Country:US
Practice Address - Phone:336-896-1323
Practice Address - Fax:336-896-1327
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)