Healthcare Provider Details

I. General information

NPI: 1205552171
Provider Name (Legal Business Name): THRIVE THERAPY MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWAY CENTER DR STE 203
GREENBELT MD
20770-3531
US

IV. Provider business mailing address

7500 GREENWAY CENTER DR STE 203
GREENBELT MD
20770-3531
US

V. Phone/Fax

Practice location:
  • Phone: 240-614-2177
  • Fax: 240-614-2177
Mailing address:
  • Phone: 240-614-2177
  • Fax: 240-614-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: JOSEE AUMILLER
Title or Position: OWNER
Credential: LCPC
Phone: 240-614-2177