Provider Demographics
NPI:1780499905
Name:RISING SPIRIT LLC
Entity type:Organization
Organization Name:RISING SPIRIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-839-9730
Mailing Address - Street 1:207 N BOONE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 N BOONE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5675
Practice Address - Country:US
Practice Address - Phone:619-839-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty