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General NPI Number Information
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NPI Number | 1134508344
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Entity Type | Organization
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Legal Business Name | THRIVE WORKS
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1355 TERRELL MILL ROAD
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 404-439-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 TERRELL MILL RD SE
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City | MARIETTA
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State | GA
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Zip | 30067-5496
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Country | US
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Telephone | 404-439-9981
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Fax |
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Authorized Official
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Title or Position | LPC/CO-OWNER
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Name | MRS. BETH EBINGER
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Credential | M.S.
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Telephone | 404-439-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC0060019
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License Number State | GA
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