Healthcare Provider Details

I. General information

NPI: 1811803547
Provider Name (Legal Business Name): UPLIFT BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 VALLEY ST BLDG 6M
PROVIDENCE RI
02909-2400
US

IV. Provider business mailing address

201 QUINCY ST
BROCKTON MA
02302-2926
US

V. Phone/Fax

Practice location:
  • Phone: 508-313-9994
  • Fax: 617-586-1102
Mailing address:
  • Phone: 508-313-9994
  • Fax: 617-586-1102

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: DONNA MARIE JOHNSON
Title or Position: VICE PRESIDENT/ CREDENTIALING MGR
Credential:
Phone: 508-301-3444