Provider Demographics
NPI:1346868288
Name:THRIVING WELL HOLISTIC WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:THRIVING WELL HOLISTIC WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LA'TOYA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-303-1795
Mailing Address - Street 1:250 W BRAMBLETON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1505
Mailing Address - Country:US
Mailing Address - Phone:757-303-1795
Mailing Address - Fax:
Practice Address - Street 1:250 W BRAMBLETON AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1505
Practice Address - Country:US
Practice Address - Phone:757-303-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty