Provider Demographics
NPI:1346003290
Name:RADICALLY THRIVE THERAPY,LLC
Entity Type:Organization
Organization Name:RADICALLY THRIVE THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-648-4402
Mailing Address - Street 1:295 ANGELL ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2119
Mailing Address - Country:US
Mailing Address - Phone:401-484-0208
Mailing Address - Fax:
Practice Address - Street 1:295 ANGELL ST STE 2B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2119
Practice Address - Country:US
Practice Address - Phone:401-484-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty