Provider Demographics
NPI:1306270996
Name:THORNTON, JESSICA LAUREL (MA, LPC, NCC, EMDR-T)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREL
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MA, LPC, NCC, EMDR-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MADIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6426
Mailing Address - Country:US
Mailing Address - Phone:304-997-1796
Mailing Address - Fax:
Practice Address - Street 1:121 SIMPSON ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-5921
Practice Address - Country:US
Practice Address - Phone:304-997-1796
Practice Address - Fax:877-471-0537
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0007030101YP2500X
WV2107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional