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General NPI Number Information
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NPI Number | 1760993562
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Entity Type | Organization
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Legal Business Name | THERATHRIVE COUNSELING, ASSESSMENT, AND WELLNESS CENTERS, A PROFESSION
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 986 MORAGA RD
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City | LAFAYETTE
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State | CA
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Zip | 94549-4423
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Country | US
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Telephone | 925-954-6229
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Fax | 925-269-8052
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Provider Business Mailing Address
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Address Line | 986 MORAGA RD
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City | LAFAYETTE
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State | CA
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Zip | 94549-4423
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Country | US
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Telephone | 925-954-6229
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Fax | 925-269-8052
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | GRACE MALONAI
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Credential | PHD, LPCC, BC-TMH
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Telephone | 925-954-6229
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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 |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC252
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License Number State | CA
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