MEDICARE: RESTORATION & NEW BEGINNINGS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	LPC009408	GA
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1972042091	OTHER		INDIVIDUAL NPI
2	2.1972042091	OTHER	GA	INDIVIDUAL NPI #

General Provider Information

NPI Number	:	1982119681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION & NEW BEGINNINGS, LLC

Provider Business Mailing Address
First Line	:	434 LAKE RIDGE LN
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-5800
Country	:	US
Telephone Number	:	404-368-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PETROL PT STE G
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1573
Country	:	US
Telephone Number	:	470-629-5424
Fax Number	:

Authorized Official
Title or Position	:	LPC/OWNER
Name	:	SHELIA J. KEY
Credential	:	LPC
Telephone Number	:	470-629-5424

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	09/18/2020

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