Healthcare Provider Details

I. General information

NPI: 1073164208
Provider Name (Legal Business Name): THRIVE FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 SIMPSON ST
GREENSBORO NC
27401-2040
US

IV. Provider business mailing address

523 SIMPSON ST
GREENSBORO NC
27401-2040
US

V. Phone/Fax

Practice location:
  • Phone: 336-542-2884
  • Fax: 336-217-8847
Mailing address:
  • Phone: 336-816-2389
  • Fax: 336-217-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. REKETTA C WRIGHT
Title or Position: PRESIDENT
Credential: LPC
Phone: 336-816-2389