Healthcare Provider Details

I. General information

NPI: 1144495979
Provider Name (Legal Business Name): RISE & EXCEL COUNSELING & COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N COLLEGE AVE SUITE 101
INDIANAPOLIS IN
46205-2734
US

IV. Provider business mailing address

3925 N COLLEGE AVE SUITE 101
INDIANAPOLIS IN
46205-2734
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-8018
  • Fax: 317-931-0943
Mailing address:
  • Phone: 317-931-8018
  • Fax: 317-931-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number674BEJ
License Number StateIN

VIII. Authorized Official

Name: DR. JACQUELINE CARROLL
Title or Position: CEO
Credential: LMHC
Phone: 317-931-8018