Healthcare Provider Details

I. General information

NPI: 1780525758
Provider Name (Legal Business Name): RESTORATION SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SEVEN HILLS ANNEX RD W STE 200
WILSON NC
27893-3688
US

IV. Provider business mailing address

400 SEVEN HILLS ANNEX RD W STE 200
WILSON NC
27893-3688
US

V. Phone/Fax

Practice location:
  • Phone: 252-343-5246
  • Fax:
Mailing address:
  • Phone: 252-343-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: KELLY D HERNDON
Title or Position: PEER SUPPORT
Credential: PEER SUPPORT
Phone: 252-343-5246