Provider Demographics
NPI:1922666007
Name:RISE COUNSELING LLC
Entity Type:Organization
Organization Name:RISE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:HARKINS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-624-7045
Mailing Address - Street 1:1317 WILMER AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4655
Mailing Address - Country:US
Mailing Address - Phone:256-624-7045
Mailing Address - Fax:
Practice Address - Street 1:1317 WILMER AVE STE 107
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4655
Practice Address - Country:US
Practice Address - Phone:256-624-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)