Provider Demographics
NPI:1346883709
Name:THRIVING POTENTIAL, PLLC
Entity Type:Organization
Organization Name:THRIVING POTENTIAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-941-7550
Mailing Address - Street 1:22 HOMESTEAD RD APT D
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1402
Mailing Address - Country:US
Mailing Address - Phone:860-941-7550
Mailing Address - Fax:
Practice Address - Street 1:2 CHAPMAN LN UNIT 11
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1222
Practice Address - Country:US
Practice Address - Phone:860-941-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health