Active NPI
Shalisa Thornburg
- Clinical Social Worker
- Greensboro, NC
National Provider Identifier
1730916701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P021166
- Practice address
- 1119 Eagle Rd
Greensboro, NC 27407-4055 - Phone
- (505) 362-4331
- NPI assigned
- Sep 16, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P021166 | NC | Primary |
Addresses
Primary practice location
1119 Eagle Rd
Greensboro, NC 27407-4055
Mailing address
1119 Eagle Rd
Greensboro, NC 27407-4055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P021166 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726444800000",
"number": "1730916701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1119 EAGLE RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274074055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1119 EAGLE RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274074055",
"telephone_number": "505-362-4331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORNBURG",
"first_name": "SHALISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-16",
"last_updated": "2024-09-16",
"certification_date": "2024-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P021166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.