=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780306738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIEF WITH RISSA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2022
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1404 S MAIN CHAPEL WAY STE 104
-----------------------------------------------------
City | GAMBRILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21054-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-264-7941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PSC 78 BOX 7226
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96326-0073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-264-7941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ THERAPIST
-----------------------------------------------------
Name | MRS. MIRISSA MERCEDES JACKSON
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 240-264-7941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------