Provider Demographics
NPI:1003461609
Name:THRIVEWELL NETWORK LLC
Entity Type:Organization
Organization Name:THRIVEWELL NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RDN, LDN, LPCA
Authorized Official - Phone:252-455-2805
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-0783
Mailing Address - Country:US
Mailing Address - Phone:252-455-2805
Mailing Address - Fax:
Practice Address - Street 1:111 W CARLTON AVE
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-7888
Practice Address - Country:US
Practice Address - Phone:252-455-2805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty