Provider Demographics
NPI:1619564929
Name:ARISE COUNSELING AND CLINICAL SERVICES
Entity Type:Organization
Organization Name:ARISE COUNSELING AND CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC NCC
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC NCC
Authorized Official - Phone:843-333-2416
Mailing Address - Street 1:1293 PROFESSIONAL DR STE D222
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5754
Mailing Address - Country:US
Mailing Address - Phone:843-606-6870
Mailing Address - Fax:843-212-6075
Practice Address - Street 1:1293 PROFESSIONAL DR STE D222
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5754
Practice Address - Country:US
Practice Address - Phone:843-606-6870
Practice Address - Fax:843-212-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1184176554Medicaid
SC1588995799Medicaid
SC1184176554OtherBLUE CROSS BLUE SHIELD, AETNA, CIGNA, UNITED HEALTHCARE, OPTUM, PAI
SC1588995799OtherBLUE CROSS BLUE SHIELD