Provider Demographics
NPI:1780191114
Name:SUNRISE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SUNRISE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISLE-BERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-494-6803
Mailing Address - Street 1:3929 LAMAR DR
Mailing Address - Street 2:STE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5083
Mailing Address - Country:US
Mailing Address - Phone:931-494-6803
Mailing Address - Fax:888-332-3984
Practice Address - Street 1:3929 LAMAR DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7354
Practice Address - Country:US
Practice Address - Phone:931-494-6803
Practice Address - Fax:888-332-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty