Healthcare Provider Details

I. General information

NPI: 1932812849
Provider Name (Legal Business Name): THE THRIVING PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 BOUNDARY ST # 204
BEAUFORT SC
29902-6802
US

IV. Provider business mailing address

35 PARRIS ISLAND GTWY # 104
BEAUFORT SC
29906-4244
US

V. Phone/Fax

Practice location:
  • Phone: 843-379-0545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAVON JENKINS
Title or Position: COUNSELOR/ THERAPIST
Credential: LPC, LAC
Phone: 843-379-0545