Provider Demographics
NPI:1457124414
Name:THRIVE AND RENEW COUNSELING LLC
Entity type:Organization
Organization Name:THRIVE AND RENEW COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMELAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-535-6771
Mailing Address - Street 1:764 E MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2921
Mailing Address - Country:US
Mailing Address - Phone:203-535-6771
Mailing Address - Fax:888-550-6771
Practice Address - Street 1:764 E MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2921
Practice Address - Country:US
Practice Address - Phone:203-535-6771
Practice Address - Fax:888-550-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty