=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275447401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACACIA THRIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 NEW BRIDGE ST # 105
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-322-1757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 CHURCHILL WAY APT 1E
-----------------------------------------------------
City | MIDWAY PARK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28544-1281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-322-1757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | RANIECE V KIRKLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-322-1757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------