Healthcare Provider Details

I. General information

NPI: 1164300497
Provider Name (Legal Business Name): REROOT AND RISE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELMAR BLVD APT K-37
WALL NJ
07719-3977
US

IV. Provider business mailing address

2510 BELMAR BLVD APT K-37
WALL NJ
07719-3977
US

V. Phone/Fax

Practice location:
  • Phone: 732-546-5004
  • Fax:
Mailing address:
  • Phone: 732-546-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MORGAN CREASE
Title or Position: OWNER
Credential: LCSW
Phone: 732-546-5004