Provider Demographics
NPI:1467973859
Name:THRIVING FAMILIES COUNSELING, LLC
Entity Type:Organization
Organization Name:THRIVING FAMILIES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-915-6472
Mailing Address - Street 1:5052 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3456
Mailing Address - Country:US
Mailing Address - Phone:540-915-6472
Mailing Address - Fax:855-515-5360
Practice Address - Street 1:1719 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2815
Practice Address - Country:US
Practice Address - Phone:540-915-6472
Practice Address - Fax:540-915-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0940053101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265442503Medicaid