Provider Demographics
NPI:1114416187
Name:RISE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:RISE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, QMHP, CSAC
Authorized Official - Phone:757-394-4523
Mailing Address - Street 1:3809 RED BARN RD STE 502
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2712
Mailing Address - Country:US
Mailing Address - Phone:757-394-4523
Mailing Address - Fax:757-282-7866
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-394-4523
Practice Address - Fax:757-282-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health