Healthcare Provider Details

I. General information

NPI: 1033858477
Provider Name (Legal Business Name): HEAL AND RESTORE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 NASH ST N
WILSON NC
27896-1729
US

IV. Provider business mailing address

2270 NASH ST N
WILSON NC
27896-1729
US

V. Phone/Fax

Practice location:
  • Phone: 252-696-4091
  • Fax: 929-290-0328
Mailing address:
  • Phone: 252-696-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANNETTE THOMAS
Title or Position: OWNER/DIRECTOR
Credential: LCSW
Phone: 252-315-4421