Healthcare Provider Details

I. General information

NPI: 1942079470
Provider Name (Legal Business Name): THRIVE NUTRITION COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 TILBURY WAY
BALTIMORE MD
21212-3504
US

IV. Provider business mailing address

5202 TILBURY WAY
BALTIMORE MD
21212-3504
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-9066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE TIZARD
Title or Position: REGISTERED DIETITIAN
Credential: MS RD LDN CSOWM
Phone: 407-489-9066