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General NPI Number Information
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NPI Number | 1063072312
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Entity Type | Organization
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Legal Business Name | RESTORE FAMILY COUNSELING, INC.
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 125
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City | ROANOKE
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State | VA
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Zip | 24018-4559
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Country | US
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Telephone | 540-519-9457
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Fax |
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Provider Business Mailing Address
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Address Line | 208 EUGENE DR NW
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City | ROANOKE
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State | VA
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Zip | 24017-4600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. DANA MCKENZIE
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Credential | LPC
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Telephone | 540-519-9457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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