Provider Demographics
NPI:1083950026
Name:THRIVE STAFFORD
Entity Type:Organization
Organization Name:THRIVE STAFFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JURRENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-446-9805
Mailing Address - Street 1:556 GARRISONVILLE RD
Mailing Address - Street 2:STE 212
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7826
Mailing Address - Country:US
Mailing Address - Phone:540-602-7266
Mailing Address - Fax:540-657-6467
Practice Address - Street 1:556 GARRISONVILLE RD
Practice Address - Street 2:STE 212
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7826
Practice Address - Country:US
Practice Address - Phone:540-602-7266
Practice Address - Fax:540-657-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty