Healthcare Provider Details

I. General information

NPI: 1275363244
Provider Name (Legal Business Name): THRIVE THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E 25TH ST FL 3
BALTIMORE MD
21218-5219
US

IV. Provider business mailing address

217 E 25TH ST FL 3
BALTIMORE MD
21218-5219
US

V. Phone/Fax

Practice location:
  • Phone: 443-506-0709
  • Fax:
Mailing address:
  • Phone: 443-506-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID PRIDGEN
Title or Position: CO OWNER
Credential:
Phone: 443-506-0709