Provider Demographics
NPI:1437643921
Name:T.H.R.I.V.E. BEHAVIORAL HEALTH & CONSULTING, LLC
Entity Type:Organization
Organization Name:T.H.R.I.V.E. BEHAVIORAL HEALTH & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAQUISTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERINNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-832-2142
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-0297
Mailing Address - Country:US
Mailing Address - Phone:609-832-2142
Mailing Address - Fax:
Practice Address - Street 1:200 CAMPBELL DR STE 105F
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-832-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty