Healthcare Provider Details

I. General information

NPI: 1770825176
Provider Name (Legal Business Name): ARISE RECOVERY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FARMER ST STE 101
NEWNAN GA
30263-8672
US

IV. Provider business mailing address

41 FARMER ST STE 101
NEWNAN GA
30263-8672
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-3150
  • Fax: 770-683-3151
Mailing address:
  • Phone: 770-683-3150
  • Fax: 770-683-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICE D ALEXANDER
Title or Position: PARTNER/CLINICAL DIRECTOR
Credential: LPC
Phone: 404-438-7736