Provider Demographics
NPI:1538924857
Name:CELESTIAL HOPE RISING SERVICES VA, LLC
Entity type:Organization
Organization Name:CELESTIAL HOPE RISING SERVICES VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KI'ASHA
Authorized Official - Middle Name:SHANTEL
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LGSW
Authorized Official - Phone:301-602-3925
Mailing Address - Street 1:3300 WILLOUGHBY RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4832
Mailing Address - Country:US
Mailing Address - Phone:301-602-3925
Mailing Address - Fax:
Practice Address - Street 1:4445 CORPORATION LN STE 264
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3671
Practice Address - Country:US
Practice Address - Phone:301-323-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty