Healthcare Provider Details

I. General information

NPI: 1043136112
Provider Name (Legal Business Name): ROBERTS HOUSE OF RESTORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 BLAKE ST
BERKELEY CA
94704-2640
US

IV. Provider business mailing address

2855 BROADWAY APT 611
OAKLAND CA
94611-5765
US

V. Phone/Fax

Practice location:
  • Phone: 510-701-0154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RHAMELL LEE STEVENSON
Title or Position: CEO
Credential: LMFT
Phone: 510-701-0154