Provider Demographics
NPI:1942870563
Name:RISE THERAPEUTIC COUNSELING
Entity Type:Organization
Organization Name:RISE THERAPEUTIC COUNSELING
Other - Org Name:FMB COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-926-3567
Mailing Address - Street 1:10601 MOUNT VERNON ST APT 202
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6910
Mailing Address - Country:US
Mailing Address - Phone:313-926-3567
Mailing Address - Fax:
Practice Address - Street 1:3200 GREENFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1805
Practice Address - Country:US
Practice Address - Phone:313-926-3567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty