Healthcare Provider Details

I. General information

NPI: 1487519914
Provider Name (Legal Business Name): RESTORING WATERS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

116 LANDMARK SQ STE 103
VIRGINIA BEACH VA
23452-6872
US

IV. Provider business mailing address

5416 BRANCHWOOD WAY
VIRGINIA BEACH VA
23464-5362
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-7170
  • Fax:
Mailing address:
  • Phone: 757-752-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILL L THOMAS
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 757-414-7170