NPIMap

Organization Active NPI

Revitalizing Inner Self Essence LLC

  • Clinical Social Worker
  • Pikesville, MD
National Provider Identifier
1114682960
Registry record updated Nov 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
REVITALIZING INNER SELF ESSENCE LLC
Practice address
17 Warren Rd Ste 3a
Pikesville, MD 21208-5001
Phone
(410) 929-6632
NPI assigned
Nov 7, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christina SimmonsNPI 1033775770
Title
Owner
Phone
(410) 929-6632

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

17 Warren Rd Ste 3a
Pikesville, MD 21208-5001

Mailing address

PO Box 1448
Owings Mills, MD 21117-1403

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@risemdllc.com

National Provider Directory

National Provider Directory

Locations

17 Warren Rd
Ste 3A
Pikesville, MD 21208
Phone (410) 591-7724

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636243200000",
    "number": "1114682960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1448",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211171403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 3A",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212085001",
            "telephone_number": "410-929-6632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZING INNER SELF ESSENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-07",
        "last_updated": "2021-11-07",
        "certification_date": "2021-11-06",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-929-6632"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@risemdllc.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "17 Warren Rd Ste 3A",
            "city": "Pikesville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212085001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pikesville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.