Healthcare Provider Details

I. General information

NPI: 1912479577
Provider Name (Legal Business Name): THRIVE ADA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 23RD ST S STE 102
BIRMINGHAM AL
35205-2462
US

IV. Provider business mailing address

1034 23RD ST S STE 102
BIRMINGHAM AL
35205-2462
US

V. Phone/Fax

Practice location:
  • Phone: 205-607-7630
  • Fax:
Mailing address:
  • Phone: 205-607-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY HARROLLE
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 205-607-7630