Healthcare Provider Details

I. General information

NPI: 1942870563
Provider Name (Legal Business Name): RISE THERAPEUTIC COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

IV. Provider business mailing address

10601 MOUNT VERNON ST APT 202
TAYLOR MI
48180-6910
US

V. Phone/Fax

Practice location:
  • Phone: 313-926-3567
  • Fax:
Mailing address:
  • Phone: 313-926-3567
  • 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. FLOANNA M BLACK
Title or Position: OWNER/CEO
Credential: MA
Phone: 313-926-3567