Provider Demographics
NPI:1528567492
Name:RISE FOR WELLNESS, LLC
Entity Type:Organization
Organization Name:RISE FOR WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARALYN
Authorized Official - Middle Name:ETHEL
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-391-4344
Mailing Address - Street 1:15 YORK ST BLDG 9
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-5532
Mailing Address - Country:US
Mailing Address - Phone:207-391-4344
Mailing Address - Fax:
Practice Address - Street 1:15 YORK ST BLDG 9
Practice Address - Street 2:SUITE 201C
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-5532
Practice Address - Country:US
Practice Address - Phone:207-391-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC154871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty