Provider Demographics
NPI:1336436112
Name:WISDOM RISING & ASSOCIATES, INTL., LLC
Entity type:Organization
Organization Name:WISDOM RISING & ASSOCIATES, INTL., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANBENSCHOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:303-378-7582
Mailing Address - Street 1:5105 DTC PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2610
Mailing Address - Country:US
Mailing Address - Phone:303-378-7582
Mailing Address - Fax:303-753-1205
Practice Address - Street 1:5105 DTC PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2610
Practice Address - Country:US
Practice Address - Phone:303-378-7582
Practice Address - Fax:303-753-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO-LCSW 9919571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106818Medicare PIN
COCO304690Medicare PIN