MEDICARE: EXPERIENCE RESTORATION CORPORATION

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1225889249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPERIENCE RESTORATION CORPORATION

Provider Business Mailing Address
First Line	:	2509 KENNON AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-4318
Country	:	US
Telephone Number	:	757-805-4813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 KENNON AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-4318
Country	:	US
Telephone Number	:	757-805-4813
Fax Number	:

Authorized Official
Title or Position	:	LMHP
Name	:	SHERRIE PATRICE WATSON
Credential	:	LPC
Telephone Number	:	757-805-4813

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	12/28/2025

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Directions to “EXPERIENCE RESTORATION CORPORATION ” Practice Location

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