Healthcare Provider Details

I. General information

NPI: 1629932835
Provider Name (Legal Business Name): RISE&RESTORE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NEW LITCHFIELD ST PH
TORRINGTON CT
06790-6609
US

IV. Provider business mailing address

310 NEW LITCHFIELD ST PH
TORRINGTON CT
06790-6609
US

V. Phone/Fax

Practice location:
  • Phone: 347-296-5355
  • Fax:
Mailing address:
  • Phone: 347-296-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE C DELICES
Title or Position: MANAGING MEMBER
Credential:
Phone: 342-296-5355