MEDICARE: RISE ABOVE THIS THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104789262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE ABOVE THIS THERAPY LLC

Provider Business Mailing Address
First Line	:	29532 SOUTHFIELD RD STE 115
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2023
Country	:	US
Telephone Number	:	313-718-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	29532 SOUTHFIELD RD STE 115
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2023
Country	:	US
Telephone Number	:	313-718-2228
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	JACQUELINE GODIN
Credential	:	LMSW
Telephone Number	:	734-355-6399

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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