Provider Demographics
NPI:1740513852
Name:THORNE, CARLTON EUGENE SR (00101781)
Entity type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:EUGENE
Last Name:THORNE
Suffix:SR
Gender:M
Credentials:00101781
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 N MARTIN ST
Mailing Address - Street 2:BLDG. 700, SUITE A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6981
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-327-4028
Practice Address - Street 1:2675 N MARTIN ST
Practice Address - Street 2:BLDG. 700, SUITE A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6981
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-327-4028
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00101781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional