Provider Demographics
NPI:1447272984
Name:THORNHILL, KATHY MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MARIE
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24958 ROAD 101A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-758-3958
Mailing Address - Fax:530-758-0537
Practice Address - Street 1:2727 DEL RIO PL
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-758-5469
Practice Address - Fax:530-758-4239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health