Provider Demographics
NPI:1538982160
Name:MOUNTAIN RISE COUNSELING, LLC
Entity type:Organization
Organization Name:MOUNTAIN RISE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:571-303-9459
Mailing Address - Street 1:315 CABLE PL
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3019
Mailing Address - Country:US
Mailing Address - Phone:240-643-8756
Mailing Address - Fax:
Practice Address - Street 1:315 CABLE PL
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3019
Practice Address - Country:US
Practice Address - Phone:571-303-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty