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General NPI Number Information
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NPI Number | 1427772904
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Entity Type | Organization
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Legal Business Name | A RESTORED YOU COUNSELING & WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 431 W LIBERTY ST UNIT 131
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City | MEDINA
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State | OH
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Zip | 44256-2221
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Country | US
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Telephone | 330-541-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 3056 DOVER DR
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City | AKRON
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State | OH
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Zip | 44312-4085
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Country | US
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Telephone | 330-541-7450
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/THERAPIST
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Name | SONSERAY TASHIA LUSTER
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Credential | LISW
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Telephone | 330-541-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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