Healthcare Provider Details

I. General information

NPI: 1376499962
Provider Name (Legal Business Name): RISE AND RESTORE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BALTIMORE BLVD STE 100
WESTMINSTER MD
21157-7065
US

IV. Provider business mailing address

909 BALTIMORE BLVD STE 100
WESTMINSTER MD
21157-7065
US

V. Phone/Fax

Practice location:
  • Phone: 443-608-7351
  • Fax:
Mailing address:
  • Phone: 443-608-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELISE PENNINGTON
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW-C
Phone: 443-880-1632