Provider Demographics
NPI:1447521307
Name:THOERIG, MICHAEL NELSON (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NELSON
Last Name:THOERIG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PROSPECT AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3204
Mailing Address - Country:US
Mailing Address - Phone:301-302-6764
Mailing Address - Fax:
Practice Address - Street 1:201 PROSPECT AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3204
Practice Address - Country:US
Practice Address - Phone:301-302-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical