Provider Demographics
NPI:1952079402
Name:RISING STRONG COUNSELING LLC
Entity Type:Organization
Organization Name:RISING STRONG COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROOSEVELT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-822-5967
Mailing Address - Street 1:401 SE 6TH ST STE 110H
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1215
Mailing Address - Country:US
Mailing Address - Phone:812-822-5967
Mailing Address - Fax:
Practice Address - Street 1:401 SE 6TH ST STE 110H
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1215
Practice Address - Country:US
Practice Address - Phone:812-822-5967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149023472OtherSTATE OF ILLINOIS
IN34009242AOtherSTATE OF INDIANA