MEDICARE: RISE UP COUNSELING & CONSULTING PLLC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871033225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE UP COUNSELING & CONSULTING PLLC

Provider Business Mailing Address
First Line	:	700 N CANNON BLVD
Second Line	:	SUITE 106
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3798
Country	:	US
Telephone Number	:	980-621-4395
Fax Number	:	704-731-7178

Provider Business Practice Location Address
First Line	:	700 N CANNON BLVD
Second Line	:	SUITE 106
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3798
Country	:	US
Telephone Number	:	980-621-4395
Fax Number	:	704-731-7178

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	MRS. SHAKEENA YVETTE SPELLER
Credential	:	LCSW, LCAS
Telephone Number	:	980-621-4395

Provider Enumeration Date	:	03/05/2017
Last Update Date	:	09/29/2022

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