MEDICARE: ARISE BEAUTIFUL 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205601051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISE BEAUTIFUL LLC

Provider Business Mailing Address
First Line	:	9805 STATESVILLE RD STE 6533
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	800-595-6301
Fax Number	:

Provider Business Practice Location Address
First Line	:	7245 POINT LAKE DR APT 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-0803
Country	:	US
Telephone Number	:	910-964-5390
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANGENETTE BURNS
Credential	:	LMHC
Telephone Number	:	800-595-6301

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/24/2023

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Directions to “ARISE BEAUTIFUL LLC ” Practice Location

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