Healthcare Provider Details

I. General information

NPI: 1023949534
Provider Name (Legal Business Name): RISE AND THRIVE YOUTH WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PARSONS AVE
COLUMBUS OH
43206-2341
US

IV. Provider business mailing address

800 PARSONS AVE
COLUMBUS OH
43206-2341
US

V. Phone/Fax

Practice location:
  • Phone: 380-282-4620
  • Fax:
Mailing address:
  • Phone: 380-282-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANNAN ENOCH
Title or Position: CERTIFIED BEHAVIORAL HEALTH SPECIAL
Credential: CBHS
Phone: 380-282-4620