Healthcare Provider Details

I. General information

NPI: 1942130448
Provider Name (Legal Business Name): THRIVEMIND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HOSPITAL DR STE 2022
CHEVERLY MD
20785-1194
US

IV. Provider business mailing address

10702 MORNING GLORY WAY
BOWIE MD
20720-4245
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-2580
  • Fax:
Mailing address:
  • Phone: 678-687-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABIDEMI SIYANBADE
Title or Position: OWNER
Credential: CRNP, PMHNP-BC
Phone: 676-687-2580