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General NPI Number Information
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NPI Number | 1851160675
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Entity Type | Organization
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Legal Business Name | FAITH RISING THERAPY, LLC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 104 LOCK AND DAM RD
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-9725
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Country | US
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Telephone | 479-567-1864
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Fax |
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Provider Business Mailing Address
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Address Line | 794 FLURRY RD
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City | DELAWARE
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State | AR
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Zip | 72835-9317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | JUSTIN QUALLS
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Credential | LPC
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Telephone | 479-567-1864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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