Healthcare Provider Details

I. General information

NPI: 1285591917
Provider Name (Legal Business Name): THRIVEWELL PSYCHIATRIC COLLABORATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8865 STANFORD BLVD STE 202
COLUMBIA MD
21045-5422
US

IV. Provider business mailing address

8865 STANFORD BLVD STE 202
COLUMBIA MD
21045-5422
US

V. Phone/Fax

Practice location:
  • Phone: 667-520-6074
  • Fax:
Mailing address:
  • Phone: 667-520-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIE LO
Title or Position: PRESIDENT
Credential: NP
Phone: 667-520-6074