Healthcare Provider Details

I. General information

NPI: 1255255428
Provider Name (Legal Business Name): HEAL & THRIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 NATHANS RIM WAY APT N16
BOWLING GREEN KY
42101-1267
US

IV. Provider business mailing address

532 NATHANS RIM WAY APT N16
BOWLING GREEN KY
42101-1267
US

V. Phone/Fax

Practice location:
  • Phone: 270-938-2762
  • Fax:
Mailing address:
  • Phone: 270-938-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KATRINA SHEREE LONG
Title or Position: ALCOHOL AND DRUG COUNSELOR
Credential: LCADC
Phone: 270-938-2762