Provider Demographics
NPI:1144495979
Name:RISE & EXCEL COUNSELING & COMMUNITY SERVICES
Entity type:Organization
Organization Name:RISE & EXCEL COUNSELING & COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-931-8018
Mailing Address - Street 1:3925 N COLLEGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2734
Mailing Address - Country:US
Mailing Address - Phone:317-931-8018
Mailing Address - Fax:317-931-0943
Practice Address - Street 1:3925 N COLLEGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2734
Practice Address - Country:US
Practice Address - Phone:317-931-8018
Practice Address - Fax:317-931-0943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERATION MINISTRIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN674BEJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863670AMedicaid