Provider Demographics
NPI:1437541877
Name:ARISE DESTINY LLC
Entity Type:Organization
Organization Name:ARISE DESTINY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/LISW-CP
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-907-8242
Mailing Address - Street 1:10211 MERIDALE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7367
Mailing Address - Country:US
Mailing Address - Phone:704-907-8242
Mailing Address - Fax:
Practice Address - Street 1:1935 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4541
Practice Address - Country:US
Practice Address - Phone:704-907-8242
Practice Address - Fax:704-973-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty