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General NPI Number Information
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NPI Number | 1093101396
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Entity Type | Organization
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Legal Business Name | THRIVE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 1268 MAIN ST SUITE 106
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City | NEWINGTON
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State | CT
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Zip | 06111-3038
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Country | US
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Telephone | 860-919-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 38 NORTHAMPTON LN
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City | PLAINVILLE
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State | CT
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Zip | 06062-1232
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Country | US
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Telephone | 860-919-6673
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | TARA SCRIVANO
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Credential | LCSW
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Telephone | 860-919-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 008029
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License Number State | CT
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