Healthcare Provider Details

I. General information

NPI: 1528971231
Provider Name (Legal Business Name): E-RISE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RAM LN
STAFFORD VA
22554-5652
US

IV. Provider business mailing address

52 TOWNES PL
FREDERICKSBURG VA
22405-2093
US

V. Phone/Fax

Practice location:
  • Phone: 227-770-0744
  • Fax:
Mailing address:
  • Phone: 227-770-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDITH NKEZE
Title or Position: OWNER
Credential: PMHNP
Phone: 227-770-0744