Healthcare Provider Details

I. General information

NPI: 1891556585
Provider Name (Legal Business Name): THRIVE WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 11TH ST STE B
ARCATA CA
95521-5838
US

IV. Provider business mailing address

770 11TH ST STE B
ARCATA CA
95521-5838
US

V. Phone/Fax

Practice location:
  • Phone: 707-267-7931
  • Fax: 707-306-7253
Mailing address:
  • Phone: 707-267-7931
  • Fax: 707-306-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CAROL ELIZABETH GRIFFIN
Title or Position: OWNER, MEDICAL DIRECTOR
Credential: DO
Phone: 707-267-7931