Healthcare Provider Details

I. General information

NPI: 1871003269
Provider Name (Legal Business Name): THRIVE COUNSELING AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WILLIAMSON RD STE 103
MOORESVILLE NC
28117-5967
US

IV. Provider business mailing address

311 WILLIAMSON RD STE 103
MOORESVILLE NC
28117-5967
US

V. Phone/Fax

Practice location:
  • Phone: 704-756-0058
  • Fax:
Mailing address:
  • Phone: 704-360-3049
  • Fax: 704-973-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL NICOLE HULETT
Title or Position: OWNER
Credential: LMFT
Phone: 704-756-0058