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General NPI Number Information
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NPI Number | 1679370159
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Entity Type | Organization
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Legal Business Name | THRIVING MINDS THERAPY, LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 102 E CECIL AVE STE B
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City | NORTH EAST
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State | MD
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Zip | 21901-4057
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Country | US
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Telephone | 667-231-1269
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Fax |
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Provider Business Mailing Address
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Address Line | 102 E CECIL AVE STE B
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City | NORTH EAST
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State | MD
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Zip | 21901-4057
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Country | US
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Telephone | 667-231-1269
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOTHERAPIST
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Name | MR. TIM DUANE GOUGH JR.
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Credential | LCSW-C
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Telephone | 443-760-0068
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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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