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General NPI Number Information
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NPI Number | 1245816750
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Entity Type | Organization
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Legal Business Name | THRIVE365, A COUNSELING AGENCY
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 961 HALL ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4645
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Country | US
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Telephone | 229-400-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 961 HALL ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4645
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Country | US
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Telephone | 229-400-8868
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | CRYSTAL JOY MICKEN
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Credential | LPC, CRC
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Telephone | 229-400-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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