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General NPI Number Information
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NPI Number | 1396216891
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Entity Type | Organization
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Legal Business Name | THRIVE IHS INTEGRATIVE HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/09/2018
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Last Update Date | 12/09/2018
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Provider Practice Location Address
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Address Line | 101 E MILLER ST
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City | ORLANDO
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State | FL
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Zip | 32806-2123
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Country | US
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Telephone | 407-963-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 9246 REYMONT ST
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City | ORLANDO
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State | FL
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Zip | 32827-3814
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Country | US
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Telephone | 407-963-5940
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Fax |
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Authorized Official
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Title or Position | DIRECTOR BEHAVIORAL HEALTH SERVICES
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Name | MR. ABRAHAM SOTO JR.
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Credential | LCSW, PH.D
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Telephone | 407-963-5940
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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 |
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License Number State |
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