Provider Demographics
NPI:1457861957
Name:SURVIVE AND THRIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:SURVIVE AND THRIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MAREN
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-201-8994
Mailing Address - Street 1:1430 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-5033
Mailing Address - Country:US
Mailing Address - Phone:618-201-8994
Mailing Address - Fax:618-213-3046
Practice Address - Street 1:617 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2204
Practice Address - Country:US
Practice Address - Phone:618-213-3046
Practice Address - Fax:618-213-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty