Healthcare Provider Details

I. General information

NPI: 1760993562
Provider Name (Legal Business Name): THERATHRIVE COUNSELING, ASSESSMENT, AND WELLNESS CENTERS, A PROFESSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 MORAGA RD
LAFAYETTE CA
94549-4423
US

IV. Provider business mailing address

986 MORAGA RD
LAFAYETTE CA
94549-4423
US

V. Phone/Fax

Practice location:
  • Phone: 925-954-6229
  • Fax: 925-269-8052
Mailing address:
  • Phone: 925-954-6229
  • Fax: 925-269-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC252
License Number StateCA

VIII. Authorized Official

Name: GRACE MALONAI
Title or Position: PRESIDENT/DIRECTOR
Credential: PHD, LPCC, BC-TMH
Phone: 925-954-6229