Healthcare Provider Details

I. General information

NPI: 1023920279
Provider Name (Legal Business Name): RISE BEHAVIOR THERAPY VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 VAN BUREN ST STE 120
HERNDON VA
20170-5336
US

IV. Provider business mailing address

205 VAN BUREN ST STE 120
HERNDON VA
20170-5336
US

V. Phone/Fax

Practice location:
  • Phone: 305-610-2811
  • Fax:
Mailing address:
  • Phone: 305-610-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LUIS ENRIQUE PADRON SPAANGBERG
Title or Position: MANAGING MEMBER
Credential:
Phone: 305-610-2811