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General NPI Number Information
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NPI Number | 1407466659
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Entity Type | Organization
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Legal Business Name | RESTORATION COUNSELING OF SOUTH ALABAMA, LLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1120 HILLCREST RD STE 2G
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City | MOBILE
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State | AL
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Zip | 36695-3955
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Country | US
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Telephone | 251-656-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 5270 RODGERS RD
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City | EIGHT MILE
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State | AL
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Zip | 36613-9136
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Country | US
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Telephone | 251-656-8036
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Fax | 205-839-8330
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Authorized Official
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Title or Position | COUNSELOR
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Name | DIANE COOK
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Credential | EDS, LPC, BC-TMH
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Telephone | 251-656-8036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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