Healthcare Provider Details

I. General information

NPI: 1851221907
Provider Name (Legal Business Name): ENVISION COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 BLAKE DR
FOREST HILL MD
21050-2739
US

IV. Provider business mailing address

817 BLAKE DR
FOREST HILL MD
21050-2739
US

V. Phone/Fax

Practice location:
  • Phone: 585-451-1060
  • Fax:
Mailing address:
  • Phone: 585-451-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JUSTINE ELISE RESTRICK
Title or Position: MANAGING MEMBER
Credential: M.ED.
Phone: 585-451-1060