Healthcare Provider Details

I. General information

NPI: 1518571371
Provider Name (Legal Business Name): RESTORATIVE ALTERNATIVE WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 SHADOWLAKE DR
OKLAHOMA CITY OK
73159-7440
US

IV. Provider business mailing address

9404 BUTTONWOOD AVE
MOORE OK
73160-9137
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-3780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GINA M PAZZAGLIA
Title or Position: OWNER
Credential: PHD, LCSW, LADC
Phone: 405-237-3780