Provider Demographics
NPI:1366985764
Name:HIGH RISE WELLNESS SERVICES
Entity type:Organization
Organization Name:HIGH RISE WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LIDIA
Authorized Official - Last Name:BOLIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MBA, NCC
Authorized Official - Phone:305-707-8615
Mailing Address - Street 1:8250 NW 27TH ST
Mailing Address - Street 2:SUITE #310
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1904
Mailing Address - Country:US
Mailing Address - Phone:305-364-5570
Mailing Address - Fax:
Practice Address - Street 1:9206 HOLLOW BEND DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5095
Practice Address - Country:US
Practice Address - Phone:305-364-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty