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General NPI Number Information
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NPI Number | 1144973116
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Entity Type | Organization
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Legal Business Name | RESTORE ADDICTION RECOVERY AND WELLNESS LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 613 BURROUGHS ST
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City | MORGANTOWN
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State | WV
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Zip | 26505-3332
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Country | US
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Telephone | 724-825-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 613 BURROUGHS ST
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City | MORGANTOWN
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State | WV
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Zip | 26505-3332
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Country | US
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Telephone | 724-825-5527
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TRAVIS L WATSON
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Credential | LPC, SAP, MAC
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Telephone | 724-825-5527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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