Provider Demographics
NPI:1710116736
Name:THRIVE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:THRIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WINONA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:NURSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:443-763-6856
Mailing Address - Street 1:PO BOX 68204
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-0027
Mailing Address - Country:US
Mailing Address - Phone:443-763-6856
Mailing Address - Fax:484-822-4276
Practice Address - Street 1:3315 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5812
Practice Address - Country:US
Practice Address - Phone:443-763-6856
Practice Address - Fax:484-822-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50078684251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management