Provider Demographics
NPI:1467911461
Name:RIZE THERAPEUTIC MENTORING SERVICE
Entity Type:Organization
Organization Name:RIZE THERAPEUTIC MENTORING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIESHKA
Authorized Official - Middle Name:RESHA
Authorized Official - Last Name:AVERY GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-808-2060
Mailing Address - Street 1:429 GREEN SPRINGS HWY STE 161
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4938
Mailing Address - Country:US
Mailing Address - Phone:205-808-2060
Mailing Address - Fax:205-945-8255
Practice Address - Street 1:429 GREEN SPRINGS HWY STE 161
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4938
Practice Address - Country:US
Practice Address - Phone:205-808-2060
Practice Address - Fax:205-945-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health