Healthcare Provider Details

I. General information

NPI: 1023614161
Provider Name (Legal Business Name): ARISE WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 CENTURION PKWY STE 104
JACKSONVILLE FL
32256-4118
US

IV. Provider business mailing address

7643 GATE PKWY STE 104-1197
JACKSONVILLE FL
32256-2893
US

V. Phone/Fax

Practice location:
  • Phone: 904-452-5027
  • Fax: 904-253-3492
Mailing address:
  • Phone: 904-802-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KORMASAH CURTIS
Title or Position: CEO, FOUNDER
Credential: LMFT
Phone: 904-802-2571