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General NPI Number Information
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NPI Number | 1811404098
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Entity Type | Organization
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Legal Business Name | RISE UP LLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 153 PARK ROW STE 103
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City | BRUNSWICK
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State | ME
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Zip | 04011-2053
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Country | US
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Telephone | 207-504-3587
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Fax |
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Provider Business Mailing Address
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Address Line | 153 PARK ROW STE 103
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City | BRUNSWICK
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State | ME
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Zip | 04011-2053
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Country | US
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Telephone | 207-504-3587
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA PACKARD
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Credential | LCPC
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Telephone | 207-504-3587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | CC4601
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | CC4601
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | CC4601
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License Number State | ME
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