Healthcare Provider Details

I. General information

NPI: 1629973979
Provider Name (Legal Business Name): THE RESTORATIVE CENTER OF CLEVELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28954 LORAIN RD STE 200
NORTH OLMSTED OH
44070-4055
US

IV. Provider business mailing address

28954 LORAIN RD STE 200
NORTH OLMSTED OH
44070-4055
US

V. Phone/Fax

Practice location:
  • Phone: 440-663-1703
  • Fax:
Mailing address:
  • Phone: 440-663-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASMINE NICOLE WALTERS
Title or Position: OWNER
Credential: LPCC
Phone: 440-663-1703