Organization
ARISE DESTINY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN AUDREY CLARK (LCSW/LISW-CP)
(704) 907-8242
Entity
Organization
Contact information
Practice address
1935 J N PEASE PL STE 101, CHARLOTTE, NC 28262-4541
(704) 907-8242
(704) 973-0694
Mailing address
10211 MERIDALE CROSSING DR, CHARLOTTE, NC 28269-7367
(704) 907-8242
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/23/2015
Last updated
12/13/2023
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