Provider Demographics
NPI:1609352525
Name:THRIVE CENTER FOR WHOLENESS, LLC
Entity Type:Organization
Organization Name:THRIVE CENTER FOR WHOLENESS, LLC
Other - Org Name:MISS
Other - Org Type:Other Name
Authorized Official - Title/Position:LPC/COO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-690-5396
Mailing Address - Street 1:2215 29TH ST SE
Mailing Address - Street 2:SUITE B8A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-404-7004
Mailing Address - Fax:616-404-7004
Practice Address - Street 1:2215 29TH ST SE
Practice Address - Street 2:SUITE B8A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-404-7004
Practice Address - Fax:616-404-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8320958Medicaid