Healthcare Provider Details

I. General information

NPI: 1972021558
Provider Name (Legal Business Name): THRIVE ADOLESCENT RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ABERCORN ST STE 403
SAVANNAH GA
31401-4069
US

IV. Provider business mailing address

127 ABERCORN ST STE 403
SAVANNAH GA
31401-4069
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 912-433-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number008000
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MIEKE PURCELL KRAMER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LPC008000
Phone: 912-433-7829