Healthcare Provider Details

I. General information

NPI: 1255029732
Provider Name (Legal Business Name): ARISE AND SHINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W CAYUGA ST
CRYSTAL SPRINGS MS
39059-2785
US

IV. Provider business mailing address

PO BOX 251
TERRY MS
39170-0251
US

V. Phone/Fax

Practice location:
  • Phone: 601-308-5026
  • Fax: 601-608-7790
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TAYLOR
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 601-308-5026