Provider Demographics
NPI:1053929786
Name:THRIVEWORKS WOODSTOCK
Entity type:Organization
Organization Name:THRIVEWORKS WOODSTOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVANDA
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:POSTELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-284-9092
Mailing Address - Street 1:225 LOGANS MILL TRL
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8964
Mailing Address - Country:US
Mailing Address - Phone:478-714-3123
Mailing Address - Fax:
Practice Address - Street 1:700 CHURCHILL CT STE 110
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6880
Practice Address - Country:US
Practice Address - Phone:770-284-9092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health