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General NPI Number Information
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NPI Number | 1528594652
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Entity Type | Organization
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Legal Business Name | THRIVE THERAPY, LLC
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 330 S MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4213
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Country | US
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Telephone | 877-711-4995
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Fax |
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Provider Business Mailing Address
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Address Line | 240 LIBERTY ST
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City | MERIDEN
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State | CT
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Zip | 06450-4408
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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 | OWNER
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Name | SHATOYA COLON
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Credential | LMFT
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Telephone | 203-671-3745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1378
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License Number State | CT
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