Healthcare Provider Details

I. General information

NPI: 1497230775
Provider Name (Legal Business Name): RESTORATION COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5868 FARINGDON PL
RALEIGH NC
27609-3931
US

IV. Provider business mailing address

16621 DOVES CANYON LN
CHARLOTTE NC
28278-8111
US

V. Phone/Fax

Practice location:
  • Phone: 919-440-8162
  • Fax:
Mailing address:
  • Phone: 919-440-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BYRON COLEY
Title or Position: CO-OWNER
Credential: LMFT
Phone: 919-440-8162