Provider Demographics
NPI:1487947347
Name:THORNE, KEVIN T (LCSW-C, LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:THORNE
Suffix:
Gender:M
Credentials:LCSW-C, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 MORRIS RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5216
Mailing Address - Country:US
Mailing Address - Phone:202-997-7588
Mailing Address - Fax:202-506-3553
Practice Address - Street 1:3231 SUPERIOR LN STE A5
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1939
Practice Address - Country:US
Practice Address - Phone:301-466-9914
Practice Address - Fax:202-506-3553
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040086671041C0700X
DCLC500800231041C0700X
MD160281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical