MEDICARE: RISE AND THRIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164374625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE AND THRIVE

Provider Business Mailing Address
First Line	:	1790 WATHEN LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-5147
Country	:	US
Telephone Number	:	703-935-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1790 WATHEN LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-5147
Country	:	US
Telephone Number	:	703-935-8964
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KINGSTON MERRITT
Credential	:
Telephone Number	:	703-935-8964

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “RISE AND THRIVE ” Practice Location

Language	Start Address	Practice Location

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