Provider Demographics
NPI:1437105186
Name:THORNSBERRY, VERONICA DAWN (LPC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:DAWN
Last Name:THORNSBERRY
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 1:1122 MONTICELLO ST SW STE 21
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2325
Mailing Address - Country:US
Mailing Address - Phone:678-712-6100
Mailing Address - Fax:678-712-6102
Practice Address - Street 1:1122 MONTICELLO ST SW STE 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2325
Practice Address - Country:US
Practice Address - Phone:678-712-6100
Practice Address - Fax:678-712-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 003068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC 003068OtherSTATE LICENSE