Provider Demographics
NPI:1871178467
Name:THRIVE OAKLAND, A LICENSED CLINICAL SOCIAL WORK CORPORATION
Entity type:Organization
Organization Name:THRIVE OAKLAND, A LICENSED CLINICAL SOCIAL WORK CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BADELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-907-6648
Mailing Address - Street 1:484 LAKE PARK AVE # 471
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2730
Mailing Address - Country:US
Mailing Address - Phone:510-907-6648
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST # 130B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:510-907-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty