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General NPI Number Information
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NPI Number | 1740879469
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Entity Type | Organization
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Legal Business Name | THRIVE INTEGRATIVE COUNSELING LLC
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 1025 E MAPLE RD STE B5
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6462
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Country | US
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Telephone | 949-836-2451
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 E MAPLE RD STE B5
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6462
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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 | HEIDI DUDGEON
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Credential |
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Telephone | 949-836-2451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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