Healthcare Provider Details

I. General information

NPI: 1215681325
Provider Name (Legal Business Name): THRIVE COUNSELING OF NORTHERN VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 WILLIAMS DR STE 300
FAIRFAX VA
22031-4648
US

IV. Provider business mailing address

8500 LAKINHURST LN
SPRINGFIELD VA
22152-1727
US

V. Phone/Fax

Practice location:
  • Phone: 571-609-3507
  • Fax:
Mailing address:
  • Phone: 571-609-3507
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DIAZ
Title or Position: THERAPIST/CO-OWNER
Credential: LPC, LMHC, NCC
Phone: 571-609-3507