Provider Demographics
NPI:1679951404
Name:ARISE THERAPY AND LIFE COACHING CENTER, LLC
Entity type:Organization
Organization Name:ARISE THERAPY AND LIFE COACHING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C
Authorized Official - Phone:240-348-6104
Mailing Address - Street 1:9135 PISCATAWAY ROAD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2555
Mailing Address - Country:US
Mailing Address - Phone:240-348-6104
Mailing Address - Fax:301-856-3051
Practice Address - Street 1:9135 PISCATAWAY ROAD.
Practice Address - Street 2:SUITE 245
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2555
Practice Address - Country:US
Practice Address - Phone:240-348-6104
Practice Address - Fax:301-856-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty