MEDICARE: RESTORATIVE COUNSELING SERVICES

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	101YP2500X	Professional Counselor	2920	AL
2	101YP2500X	Professional Counselor	2972	AL
3	1041C0700X	Clinical Social Worker	3600C	AL

General Provider Information

NPI Number	:	1699170944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	181 W VALLEY AVE STE 112
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:	205-675-6592
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 W VALLEY AVE STE 112
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:	205-675-6592
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MONIQUE SHANDRELL JOHNSON
Credential	:	LPC
Telephone Number	:	205-381-0929

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	10/30/2014

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Directions to “RESTORATIVE COUNSELING SERVICES ” Practice Location

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