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General NPI Number Information
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NPI Number | 1972021558
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Entity Type | Organization
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Legal Business Name | THRIVE ADOLESCENT RECOVERY, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 127 ABERCORN ST STE 403
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City | SAVANNAH
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State | GA
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Zip | 31401-4069
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 127 ABERCORN ST STE 403
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City | SAVANNAH
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State | GA
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Zip | 31401-4069
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Country | US
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Telephone | 912-433-7829
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MIEKE PURCELL KRAMER
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Credential | LPC008000
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Telephone | 912-433-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 008000
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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