Healthcare Provider Details

I. General information

NPI: 1619254299
Provider Name (Legal Business Name): PROJECT UPLIFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 OMAHA ST
RENO NV
89506-8813
US

IV. Provider business mailing address

2300 HARVARD WAY # 105
RENO NV
89502-4002
US

V. Phone/Fax

Practice location:
  • Phone: 775-379-0748
  • Fax:
Mailing address:
  • Phone: 775-379-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-2101
License Number StateNV

VIII. Authorized Official

Name: MR. ALONZO HICKERSON
Title or Position: OWNER OPERATOR
Credential:
Phone: 775-379-0748