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General NPI Number Information
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NPI Number | 1245747880
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Entity Type | Organization
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Legal Business Name | RISE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 5710 SAINT JOSEPH AVE
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City | STEVENSVILLE
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State | MI
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Zip | 49127-1240
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Country | US
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Telephone | 269-830-4436
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Fax | 269-588-3047
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Provider Business Mailing Address
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Address Line | 5710 SAINT JOSEPH AVE
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City | STEVENSVILLE
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State | MI
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Zip | 49127-1240
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Country | US
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Telephone | 269-830-4436
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Fax | 269-588-3047
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LESLIE ANNE NAVARRO
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Credential | LMSW, CAADC
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Telephone | 269-830-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-03260
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092641
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License Number State | MI
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