Healthcare Provider Details

I. General information

NPI: 1346868288
Provider Name (Legal Business Name): THRIVING WELL HOLISTIC WELLNESS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W BRAMBLETON AVE STE 101
NORFOLK VA
23510-1505
US

IV. Provider business mailing address

250 W BRAMBLETON AVE STE 101
NORFOLK VA
23510-1505
US

V. Phone/Fax

Practice location:
  • Phone: 757-303-1795
  • Fax:
Mailing address:
  • Phone: 757-303-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LA'TOYA NICOLE EDWARDS
Title or Position: CEO
Credential: LCSW
Phone: 757-303-1795