MEDICARE: CONSCIOUSNESS RISING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904006837	VA

General Provider Information

NPI Number	:	1265860308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSCIOUSNESS RISING, INC.

Provider Business Mailing Address
First Line	:	4509 WHITECHAPEL DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6447
Country	:	US
Telephone Number	:	757-460-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	4919 CYPRESS POINT CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6847
Country	:	US
Telephone Number	:	757-460-4655
Fax Number	:	757-460-7744

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNA ASHTON SMITH
Credential	:	LCSW
Telephone Number	:	757-460-4655

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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