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General NPI Number Information
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NPI Number | 1255094074
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Entity Type | Organization
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Legal Business Name | RESTORE COUNSELING SERVICES
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 12762 SW 184TH TER
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City | MIAMI
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State | FL
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Zip | 33177-2503
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Country | US
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Telephone | 305-385-0066
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Fax | 305-468-6182
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Provider Business Mailing Address
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Address Line | 12762 SW 184TH TER
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City | MIAMI
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State | FL
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Zip | 33177-2503
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Country | US
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Telephone | 305-389-2626
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNNETTTE FULLER- KENNERLY
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Credential | LMHC
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Telephone | 305-385-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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