Organization
RIZING STARZ,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESEREE BOLERE (OWNER)
(804) 926-5268
Entity
Organization
Contact information
Practice address
31C SOUTH JEFFERSON ST, PETERSBURG, VA 23803-4331
(804) 926-5268
Mailing address
31C SOUTH JEFFERSON ST, PETERSBURG, VA 23803-4331
(804) 926-5268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/18/2012
Last updated
05/18/2012
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