Healthcare Provider Details

I. General information

NPI: 1609352525
Provider Name (Legal Business Name): THRIVE CENTER FOR WHOLENESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 09/06/2023
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 29TH ST SE SUITE B8A
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

2215 29TH ST SE SUITE B8A
GRAND RAPIDS MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-404-7004
  • Fax: 616-404-7004
Mailing address:
  • Phone: 616-404-7004
  • Fax: 616-404-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301015845
License Number StateMI

VIII. Authorized Official

Name: NICOLE BROWN
Title or Position: LPC/COO
Credential: LPC
Phone: 616-690-5396