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General NPI Number Information
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NPI Number | 1134501836
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Entity Type | Organization
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Legal Business Name | RESTORATION COUNSELING, LLC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 2 W ROLLING SUITE 210
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City | CATONSVILLE
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State | MD
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Zip | 21228-6208
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Country | US
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Telephone | 410-744-7014
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Fax | 410-744-6903
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Provider Business Mailing Address
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Address Line | 4709 CREEKSIDE CIR APARTMENT 302
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City | OWINGS MILLS
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State | MD
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Zip | 21117-7125
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Country | US
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Telephone | 919-332-4043
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | KRYSTAL LASHON SMITH
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Credential | LCSW-C
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Telephone | 919-332-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 15128
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 15128
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 15128
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License Number State | MD
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