Healthcare Provider Details

I. General information

NPI: 1891564720
Provider Name (Legal Business Name): THRIVE THERAPY BOONE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 N WATER ST STE 2
BOONE NC
28607-3556
US

IV. Provider business mailing address

651 S SUNSET DR
WINSTON SALEM NC
27103-3852
US

V. Phone/Fax

Practice location:
  • Phone: 828-719-6818
  • Fax:
Mailing address:
  • Phone: 828-719-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MERIDITH MERCER HATHORN
Title or Position: CEO & COUNSELOR
Credential: LCMHC
Phone: 828-719-6818