Healthcare Provider Details

I. General information

NPI: 1700592847
Provider Name (Legal Business Name): RISING ANCHOR INDIVIDUAL MARRIAGE AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S ALAMEDA ST FL 2
LOS ANGELES CA
90021-1657
US

IV. Provider business mailing address

203 WASHINGTON ST # 121
SALEM MA
01970-3607
US

V. Phone/Fax

Practice location:
  • Phone: 424-571-9768
  • Fax:
Mailing address:
  • Phone: 424-571-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON WILLIAMS
Title or Position: CEO
Credential: LMFT
Phone: 401-824-4540