Provider Demographics
NPI:1124651930
Name:I-THRIVE THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:I-THRIVE THERAPY AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-761-9425
Mailing Address - Street 1:4036 RAVINE GAP DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3050
Mailing Address - Country:US
Mailing Address - Phone:401-359-1739
Mailing Address - Fax:
Practice Address - Street 1:2005 OLD GREENBRIER RD STE 107
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2649
Practice Address - Country:US
Practice Address - Phone:757-761-9425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty