Healthcare Provider Details

I. General information

NPI: 1508007360
Provider Name (Legal Business Name): RESTORATION CHRISTIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2009
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W OAK ST
NICHOLASVILLE KY
40356-1244
US

IV. Provider business mailing address

101 WILLOW DR
NICHOLASVILLE KY
40356-1459
US

V. Phone/Fax

Practice location:
  • Phone: 859-382-0132
  • Fax:
Mailing address:
  • Phone: 859-382-0132
  • Fax: 859-881-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0485
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3037
License Number StateKY

VIII. Authorized Official

Name: CATHLEEN C. DONAHUE
Title or Position: MEMBER
Credential: L.P.C.C.
Phone: 859-382-0132