Provider Demographics
NPI:1740644954
Name:THORNTON, DOMINIQUE (LCSW)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:DEVILBISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2070 JORDAN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-9329
Mailing Address - Country:US
Mailing Address - Phone:775-997-9960
Mailing Address - Fax:
Practice Address - Street 1:85 KEYSTONE AVE STE 205
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5571
Practice Address - Country:US
Practice Address - Phone:775-997-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7507-S104100000X
NV8807-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker