Provider Demographics
NPI:1760993562
Name:THERATHRIVE COUNSELING, ASSESSMENT, AND WELLNESS CENTERS, A PROFESSION
Entity Type:Organization
Organization Name:THERATHRIVE COUNSELING, ASSESSMENT, AND WELLNESS CENTERS, A PROFESSION
Other - Org Name:THERATHRIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCC, BC-TMH
Authorized Official - Phone:925-954-6229
Mailing Address - Street 1:986 MORAGA RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4423
Mailing Address - Country:US
Mailing Address - Phone:925-954-6229
Mailing Address - Fax:925-269-8052
Practice Address - Street 1:986 MORAGA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4423
Practice Address - Country:US
Practice Address - Phone:925-954-6229
Practice Address - Fax:925-269-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 103TC0700X, 103TC1900X, 106H00000X
CALPCC252101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC252OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES
1598894123OtherNPPES