Healthcare Provider Details

I. General information

NPI: 1205545241
Provider Name (Legal Business Name): THRIVING THERAPY AND RESIDENTIAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 SPERRY BRANCH WAY APT G
FAYETTEVILLE NC
28306-9160
US

IV. Provider business mailing address

3210 SPERRY BRANCH WAY APT G
FAYETTEVILLE NC
28306-9160
US

V. Phone/Fax

Practice location:
  • Phone: 910-224-1094
  • Fax:
Mailing address:
  • Phone: 910-224-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS BIANCA FAITH MONROE
Title or Position: PSYCHOTHERAPIST
Credential: MSW, LCSW-A, LCAS-A
Phone: 910-224-1094