Provider Demographics
NPI:1275230682
Name:THRIVE MI, PLLC
Entity Type:Organization
Organization Name:THRIVE MI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER OF CLINICAL SOCIAL WORK
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-860-1067
Mailing Address - Street 1:21122 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:MI
Mailing Address - Zip Code:48637-9771
Mailing Address - Country:US
Mailing Address - Phone:989-860-1067
Mailing Address - Fax:
Practice Address - Street 1:21122 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:MI
Practice Address - Zip Code:48637-9771
Practice Address - Country:US
Practice Address - Phone:989-860-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558929125OtherNPI