Provider Demographics
NPI:1801947593
Name:RISING, MARILYN CLARICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:CLARICE
Last Name:RISING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MACK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1072
Mailing Address - Country:US
Mailing Address - Phone:336-953-6136
Mailing Address - Fax:
Practice Address - Street 1:933 MACK RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-1072
Practice Address - Country:US
Practice Address - Phone:336-953-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003209Medicaid
NC2874786BMedicare PIN