Provider Demographics
NPI:1851116842
Name:HEAL GROW EVOLVE THRIVE LLC
Entity type:Organization
Organization Name:HEAL GROW EVOLVE THRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:380-267-8285
Mailing Address - Street 1:PO BOX 13028
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-0028
Mailing Address - Country:US
Mailing Address - Phone:380-267-8285
Mailing Address - Fax:
Practice Address - Street 1:1744 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1511
Practice Address - Country:US
Practice Address - Phone:380-267-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health