Provider Demographics
NPI:1326274093
Name:TRINITY PLACE RISING SOLUTIONS, INC.
Entity type:Organization
Organization Name:TRINITY PLACE RISING SOLUTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC
Authorized Official - Phone:980-949-8811
Mailing Address - Street 1:16948 COMMONS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2077
Mailing Address - Country:US
Mailing Address - Phone:704-293-1901
Mailing Address - Fax:
Practice Address - Street 1:5501 EXECUTIVE CENTER DR STE 217
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8823
Practice Address - Country:US
Practice Address - Phone:980-949-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12067101Y00000X, 101YM0800X
251S00000X, 261QM0801X, 261QM0850X, 261QM0855X, 332U00000X, 347C00000X, 261QI0500X, 261QM0801X, 261QM0850X, 261QM0855X, 332U00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy