Healthcare Provider Details

I. General information

NPI: 1164366969
Provider Name (Legal Business Name): RISING UP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 MAIN STREET B-4
BUZZARDS BAY MA
02532-3222
US

IV. Provider business mailing address

258 MAIN STREET B-4
BUZZARDS BAY MA
02532-3222
US

V. Phone/Fax

Practice location:
  • Phone: 508-207-0071
  • Fax: 508-452-6328
Mailing address:
  • Phone: 508-207-0071
  • Fax: 508-452-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEIGH-ANN LARSON
Title or Position: CEO
Credential: LMHC-6519 MA
Phone: 208-207-0071