Healthcare Provider Details

I. General information

NPI: 1477471266
Provider Name (Legal Business Name): RELEASE AND RESTORATION THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11434 LUCERNE
REDFORD MI
48239-2282
US

IV. Provider business mailing address

PO BOX 40041
REDFORD MI
48240-0041
US

V. Phone/Fax

Practice location:
  • Phone: 313-444-2164
  • Fax: 213-283-6241
Mailing address:
  • Phone: 313-444-2164
  • Fax: 213-283-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DESIREE L JOHNSON
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 313-444-2164