Provider Demographics
NPI:1518559285
Name:R.I.S.E FAMILY SERVICES LLC
Entity type:Organization
Organization Name:R.I.S.E FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:240-918-0861
Mailing Address - Street 1:9811 MALLARD DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3199
Mailing Address - Country:US
Mailing Address - Phone:301-778-8835
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 203
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3199
Practice Address - Country:US
Practice Address - Phone:301-778-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.I.S.E FAMILY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No251B00000XAgenciesCase Management