Healthcare Provider Details

I. General information

NPI: 1275447401
Provider Name (Legal Business Name): ACACIA THRIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEW BRIDGE ST # 105
JACKSONVILLE NC
28540-4736
US

IV. Provider business mailing address

1001 CHURCHILL WAY APT 1E
MIDWAY PARK NC
28544-1281
US

V. Phone/Fax

Practice location:
  • Phone: 330-322-1757
  • Fax:
Mailing address:
  • Phone: 330-322-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: RANIECE V KIRKLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-322-1757