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General NPI Number Information
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NPI Number | 1215749114
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Entity Type | Organization
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Legal Business Name | RESTORATION TRANSFORMATION
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 235 PELICAN PL UNIT 3
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City | DESTIN
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State | FL
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Zip | 32541-7317
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Country | US
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Telephone | 580-747-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 10355 PARADISE BLVD APT 704
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City | TREASURE ISLAND
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State | FL
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Zip | 33706-3132
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Country | US
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Telephone | 580-747-0181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE ANN UNDERWOOD
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Credential |
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Telephone | 580-747-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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