Provider Demographics
NPI:1992061022
Name:RISING HOPE FAMILY COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:RISING HOPE FAMILY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VANDER WIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-915-7198
Mailing Address - Street 1:1486 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1133
Mailing Address - Country:US
Mailing Address - Phone:920-915-7198
Mailing Address - Fax:
Practice Address - Street 1:1486 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1133
Practice Address - Country:US
Practice Address - Phone:920-739-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7710-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7710-123OtherSTATE OF WISCONSIN