Provider Demographics
NPI:1942938618
Name:THORNBURG, KIMBERLEY MICHELLE (MA, LPC-A)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLEY
Middle Name:MICHELLE
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 WOOLWINE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8843
Mailing Address - Country:US
Mailing Address - Phone:828-855-8170
Mailing Address - Fax:803-459-1550
Practice Address - Street 1:1 CHICK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4946
Practice Address - Country:US
Practice Address - Phone:910-434-4970
Practice Address - Fax:866-813-6192
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional