MEDICARE: URBAN RESTORATION COUNSELING CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	172V00000X	Community Health Worker
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	106H00000X	Marriage & Family Therapist
5	104100000X	Social Worker
6	171M00000X	Case Manager/Care Coordinator
7	101YM0800X	Mental Health Counselor
8	101Y00000X	Counselor

General Provider Information

NPI Number	:	1710784319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN RESTORATION COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1925 EUCLID AVE STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5362
Country	:	US
Telephone Number	:	619-648-1158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 EUCLID AVE STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5362
Country	:	US
Telephone Number	:	619-648-1158
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	SHANELLE D. JOHNSON
Credential	:	LMFT
Telephone Number	:	619-343-9543

Provider Enumeration Date	:	03/01/2025
Last Update Date	:	05/07/2026

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