MEDICARE: TRINITY PLACE RISING SOLUTIONS, INC.

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	347C00000X	Private Vehicle
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	101Y00000X	Counselor	A12067	NC
4	101YM0800X	Mental Health Counselor	A12067	NC
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	261QM0850X	Adult Mental Health Clinic/Center
7	332U00000X	Home Delivered Meals
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326274093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY PLACE RISING SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	16948 COMMONS CREEK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2077
Country	:	US
Telephone Number	:	704-293-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 EXECUTIVE CENTER DR STE 217
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8823
Country	:	US
Telephone Number	:	980-949-8811
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	TAMARA HICKS
Credential	:	MS, LCMHC
Telephone Number	:	980-949-8811

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	11/05/2024

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