Healthcare Provider Details

I. General information

NPI: 1023964848
Provider Name (Legal Business Name): UPRISING SUPPORTIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WILLIAMS ST STE 109
LANCASTER SC
29720-2404
US

IV. Provider business mailing address

114 WILLIAMS ST STE 109
LANCASTER SC
29720-2404
US

V. Phone/Fax

Practice location:
  • Phone: 803-639-7700
  • Fax: 803-753-0088
Mailing address:
  • Phone: 803-639-7700
  • Fax: 803-753-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE VENTOUR
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 917-379-4989