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General NPI Number Information
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NPI Number | 1750976098
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Entity Type | Organization
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Legal Business Name | CONNECT GROW THRIVE LLC
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 3295 RIVER EXCHANGE DR STE 125
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-4248
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Country | US
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Telephone | 803-667-4406
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Fax | 803-486-2506
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Provider Business Mailing Address
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Address Line | 1705 RICHLAND ST STE C
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City | COLUMBIA
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State | SC
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Zip | 29201-2635
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Country | US
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Telephone | 803-667-4406
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Fax | 803-486-2506
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMASINA ODOM LAWSON
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Credential | LPC
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Telephone | 803-667-4406
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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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