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General NPI Number Information
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NPI Number | 1831072180
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Entity Type | Organization
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Legal Business Name | THRIVE TEEN THERAPY LICENSED CLINICAL SOCIAL WORKER APC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 35 E 10TH ST
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City | TRACY
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State | CA
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Zip | 95376-4058
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Country | US
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Telephone | 650-660-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 SHOFIELD CT
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City | TRACY
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State | CA
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Zip | 95377-8502
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Country | US
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Telephone | 650-660-9660
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CLINICIAN
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Name | NICOLE DHAMNASKAR
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Credential | LCSW
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Telephone | 650-660-9660
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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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