Provider Demographics
NPI:1023572773
Name:THRIVE COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:THRIVE COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-419-3665
Mailing Address - Street 1:108 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4216
Mailing Address - Country:US
Mailing Address - Phone:256-419-3665
Mailing Address - Fax:256-270-2777
Practice Address - Street 1:108 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4216
Practice Address - Country:US
Practice Address - Phone:256-419-3665
Practice Address - Fax:256-270-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1518478619Medicaid