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General NPI Number Information
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NPI Number | 1023964848
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Entity Type | Organization
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Legal Business Name | UPRISING SUPPORTIVE SERVICES
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 114 WILLIAMS ST STE 109
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City | LANCASTER
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State | SC
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Zip | 29720-2404
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Country | US
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Telephone | 803-639-7700
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Fax | 803-753-0088
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Provider Business Mailing Address
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Address Line | 114 WILLIAMS ST STE 109
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City | LANCASTER
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State | SC
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Zip | 29720-2404
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Country | US
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Telephone | 803-639-7700
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Fax | 803-753-0088
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | NICOLE VENTOUR
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Credential | LCSW
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Telephone | 917-379-4989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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