Healthcare Provider Details

I. General information

NPI: 1093422081
Provider Name (Legal Business Name): RISING HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MUIRS CHAPEL RD STE 124
GREENSBORO NC
27410-6100
US

IV. Provider business mailing address

PO BOX 17365
WINSTON SALEM NC
27116-7365
US

V. Phone/Fax

Practice location:
  • Phone: 336-331-0978
  • Fax:
Mailing address:
  • Phone: 336-331-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTINA ANULIKA OKONKWO
Title or Position: PSYCH NURSE PRACTITIONER
Credential:
Phone: 336-331-0978