Provider Demographics
NPI:1134947153
Name:THORNTON, VIRGINIA ASHLEY (LPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ASHLEY
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 N BELL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3676
Mailing Address - Country:US
Mailing Address - Phone:773-573-3260
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 7TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1112
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health