MEDICARE: RISING WELLNESS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619686649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING WELLNESS COUNSELING LLC

Provider Business Mailing Address
First Line	:	47 SIMMERS RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-2304
Country	:	US
Telephone Number	:	443-350-4667
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 SIMMERS RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-2304
Country	:	US
Telephone Number	:	443-350-4667
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVANN L REICHENBACH
Credential	:	LCSW-C
Telephone Number	:	443-350-4667

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	04/07/2023

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