Healthcare Provider Details

I. General information

NPI: 1316611064
Provider Name (Legal Business Name): RISING UP COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 DURHAM RD
WALLINGFORD CT
06492-2526
US

IV. Provider business mailing address

1145 N COLONY RD
WALLINGFORD CT
06492-1796
US

V. Phone/Fax

Practice location:
  • Phone: 203-741-8656
  • Fax:
Mailing address:
  • Phone: 203-741-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRAZIELLA LUCIA MOLLUZZO-LOESCHE
Title or Position: LICENSED CLINICAL SOCIAL WORKER/OWN
Credential: LCSW
Phone: 32-741-8656