Healthcare Provider Details

I. General information

NPI: 1700758802
Provider Name (Legal Business Name): COURAGE TO THRIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 KINGSLEY AVE STE 203
ORANGE PARK FL
32073-5685
US

IV. Provider business mailing address

108 KINGSLEY AVE STE 203
ORANGE PARK FL
32073-5685
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-1656
  • Fax: 904-830-0768
Mailing address:
  • Phone: 904-505-1656
  • Fax: 904-830-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARLENE WHITE
Title or Position: LMHC/OWNER
Credential: LMHC
Phone: 904-505-1656