Provider Demographics
NPI:1053851865
Name:THRIVE ADDICTIONS SERVICES
Entity type:Organization
Organization Name:THRIVE ADDICTIONS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, CCS, MAC
Authorized Official - Phone:910-483-8500
Mailing Address - Street 1:1611B OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-483-8500
Mailing Address - Fax:910-483-5864
Practice Address - Street 1:1611B OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-483-8500
Practice Address - Fax:910-483-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-962261QM0850X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111996Medicaid