=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144559733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARISE COUNSELING & CONSULTING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5706 TURNEY RD SUITE 205
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-3971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-820-1180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25352
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-820-1180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DIRECTOR
-----------------------------------------------------
Name | MS. LISA RENEE RODGERS
-----------------------------------------------------
Credential | M.ED., LPCC-S
-----------------------------------------------------
Telephone | 216-820-1180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C0600139
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------