Healthcare Provider Details

I. General information

NPI: 1184362253
Provider Name (Legal Business Name): CELESTIAL HOPE RISING SERVICES VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 06/11/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST GROUND SUITE
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

4445 CORPORATION LN STE 264
VIRGINIA BEACH VA
23462-3671
US

V. Phone/Fax

Practice location:
  • Phone: 301-323-8437
  • Fax:
Mailing address:
  • Phone: 301-602-3925
  • Fax:

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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KI'ASHA SANDERS
Title or Position: FOUNDER/CEO
Credential: LCSW-C, LGSW
Phone: 301-602-3925