Provider Demographics
NPI:1629546262
Name:THRIVE COUNSELING AND CONSULTATION
Entity Type:Organization
Organization Name:THRIVE COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:DIJON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-421-9940
Mailing Address - Street 1:1708 E KIRBY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-3536
Mailing Address - Country:US
Mailing Address - Phone:440-382-8707
Mailing Address - Fax:
Practice Address - Street 1:2810 W SAINT ISABEL ST STE 201B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6375
Practice Address - Country:US
Practice Address - Phone:813-421-9940
Practice Address - Fax:813-422-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty