Healthcare Provider Details

I. General information

NPI: 1215541446
Provider Name (Legal Business Name): RESTORE BALANCE AND WELLNESS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S HIGH ST
ZELIENOPLE PA
16063-1375
US

IV. Provider business mailing address

1099 DAVIS RD
ELLWOOD CITY PA
16117-8019
US

V. Phone/Fax

Practice location:
  • Phone: 443-783-6920
  • Fax:
Mailing address:
  • Phone: 443-783-6920
  • 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: CHRISTINA LUCAS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 443-783-6920