Healthcare Provider Details

I. General information

NPI: 1255084828
Provider Name (Legal Business Name): RISE IN LOVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 CUMBERLAND DR
LARGO FL
33773-1605
US

IV. Provider business mailing address

12851 CUMBERLAND DR
LARGO FL
33773-1605
US

V. Phone/Fax

Practice location:
  • Phone: 727-642-4746
  • Fax:
Mailing address:
  • Phone: 727-642-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MEGAN SZCZEPANIK
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 727-642-4746