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General NPI Number Information
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NPI Number | 1225889249
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Entity Type | Organization
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Legal Business Name | EXPERIENCE RESTORATION CORPORATION
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 2509 KENNON AVE
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City | NORFOLK
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State | VA
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Zip | 23513-4318
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Country | US
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Telephone | 757-805-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 KENNON AVE
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City | NORFOLK
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State | VA
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Zip | 23513-4318
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Country | US
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Telephone | 757-805-4813
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Fax |
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Authorized Official
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Title or Position | LMHP
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Name | SHERRIE PATRICE WATSON
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Credential | LPC
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Telephone | 757-805-4813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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