Provider Demographics
NPI:1407251341
Name:THRIVE PSYCHOTHERAPY AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:THRIVE PSYCHOTHERAPY AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DOYNE
Authorized Official - Last Name:FAILING
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:843-694-1528
Mailing Address - Street 1:219 SCOTT ST # 128
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5554
Mailing Address - Country:US
Mailing Address - Phone:843-694-1528
Mailing Address - Fax:
Practice Address - Street 1:219 SCOTT ST # 128
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5554
Practice Address - Country:US
Practice Address - Phone:843-694-1528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health