| Rise Family Services | |
|
9811 Mallard Dr Ste 203 Laurel MD 20708-3199 | |
| (240) 817-8411 | |
| Not Available |
| Full Name | Rise Family Services |
|---|---|
| Speciality | Counselor |
| Location | 9811 Mallard Dr Ste 203, Laurel, Maryland |
| Authorized Official Name and Position | Shonnell Ham (FOUNDER/ CEO) |
| Authorized Official Contact | 2408178411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rise Family Services 13603 Avebury Dr Apt 12 Laurel MD 20708-3439 Ph: () - | Rise Family Services 9811 Mallard Dr Ste 203 Laurel MD 20708-3199 Ph: (240) 817-8411 |
| NPI Number | 1124648456 |
|---|---|
| Provider Enumeration Date | 04/16/2020 |
| Last Update Date | 05/09/2022 |
| Certification Date | 05/09/2022 |
| Medicare PECOS PAC ID | 8729474903 |
|---|---|
| Medicare Enrollment ID | O20220418000006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124648456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gregory Anyinam Obiwuma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164052692 PECOS PAC ID: 2961802905 Enrollment ID: I20210614002149 |
| Provider Name | Shonnell Shelton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679152441 PECOS PAC ID: 9638565815 Enrollment ID: I20220418000028 |
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