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General NPI Number Information
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NPI Number | 1316521479
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Entity Type | Organization
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Legal Business Name | THRIVE MIND & BODY, A LICENSED CLINICAL SOCIAL WORK CORPORATION
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 2819 W MARCH LN STE B6-221
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City | STOCKTON
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State | CA
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Zip | 95219-8209
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Country | US
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Telephone | 415-943-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 2819 W MARCH LN STE B6-221
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City | STOCKTON
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State | CA
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Zip | 95219-8209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ISAURA RIZZO
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Credential | LCSW
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Telephone | 415-943-0340
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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