Healthcare Provider Details

I. General information

NPI: 1225586308
Provider Name (Legal Business Name): MINDFULLY THRIVE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JEROME AVENUE SUITE 318
BLOOMFIELD CT
06002-2445
US

IV. Provider business mailing address

34 JEROME AVENUE SUITE 318
BLOOMFIELD CT
06002-2445
US

V. Phone/Fax

Practice location:
  • Phone: 860-458-6118
  • Fax:
Mailing address:
  • Phone: 860-458-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007540
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LATOYA HINDS
Title or Position: OWNER
Credential: LCSW
Phone: 860-458-6118