Healthcare Provider Details

I. General information

NPI: 1770378812
Provider Name (Legal Business Name): RESTORED CHRISTIAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE COAKLAND
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

PO BOX 204
MECHANICSVILLE MD
20659-0204
US

V. Phone/Fax

Practice location:
  • Phone: 240-230-7724
  • Fax:
Mailing address:
  • Phone: 240-230-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LUKE JOHANNI
Title or Position: CLINIC DIRECTOR & CLINICIAN
Credential:
Phone: 216-376-0633