Healthcare Provider Details

I. General information

NPI: 1336779560
Provider Name (Legal Business Name): THRIVE BEHAVIOR HEALTH AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9779 GOOD LUCK RD APT 5
LANHAM MD
20706-3338
US

IV. Provider business mailing address

9779 GOOD LUCK RD APT 5
LANHAM MD
20706-3338
US

V. Phone/Fax

Practice location:
  • Phone: 240-350-2863
  • Fax:
Mailing address:
  • Phone: 240-350-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILDINE BURGESS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 240-350-2863