Healthcare Provider Details

I. General information

NPI: 1801710066
Provider Name (Legal Business Name): NOVARISE COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

146 MALLARD DR
SUFFOLK VA
23434-8093
US

IV. Provider business mailing address

146 MALLARD DR
SUFFOLK VA
23434-8093
US

V. Phone/Fax

Practice location:
  • Phone: 757-636-3804
  • Fax: 757-636-3804
Mailing address:
  • Phone: 757-636-3804
  • Fax: 757-636-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MICHELE GODGOW-PARSHALL
Title or Position: OWNER
Credential: LCSW
Phone: 757-636-3804