Healthcare Provider Details

I. General information

NPI: 1770184251
Provider Name (Legal Business Name): THINK TO THRIVE PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NORTHLAND DR STE 204B
SOUTHFIELD MI
48075-5205
US

IV. Provider business mailing address

3070 WHISPERWOOD DR APT 417
ANN ARBOR MI
48105-3419
US

V. Phone/Fax

Practice location:
  • Phone: 415-336-7707
  • Fax:
Mailing address:
  • Phone: 415-336-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANTE DEMITRIUS DIXSON
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 415-336-7707