Provider Demographics
NPI:1245946672
Name:T.H.R.I.V.E COUNSELING AND WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:T.H.R.I.V.E COUNSELING AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMCH
Authorized Official - Phone:407-476-8877
Mailing Address - Street 1:2582 MAGUIRE RD # 131
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4749
Mailing Address - Country:US
Mailing Address - Phone:407-476-8877
Mailing Address - Fax:
Practice Address - Street 1:3200 OLD WINTER GARDEN RD APT 1822
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4539
Practice Address - Country:US
Practice Address - Phone:216-390-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083160337OtherNPI