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General NPI Number Information
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NPI Number | 1053944074
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Entity Type | Organization
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Legal Business Name | RESTORATIVE COUNSELING & CONSULTATION, A CLINICAL SOCIAL WORK CORPORAT
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 4126 TELEGRAPH AVE.
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City | OAKLAND
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State | CA
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Zip | 94609-9460
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Country | US
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Telephone | 510-686-3116
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Fax | 877-346-7602
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Provider Business Mailing Address
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Address Line | 3022 73RD AVE
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City | OAKLAND
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State | CA
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Zip | 94605-2541
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Country | US
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Telephone | 510-329-8463
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Fax | 877-346-7602
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELLE NICHOLAS
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Credential | LCSW
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Telephone | 510-329-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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