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General NPI Number Information
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NPI Number | 1508227398
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Entity Type | Organization
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Legal Business Name | RESTORATIVE HEALING COUNSELING & PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 108 S WYNSTONE PARK DR
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City | NORTH BARRINGTON
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State | IL
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Zip | 60010-6923
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Country | US
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Telephone | 847-942-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 108 S WYNSTONE PARK DR
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City | NORTH BARRINGTON
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State | IL
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Zip | 60010-6923
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Country | US
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Telephone | 847-942-4920
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | NICOLE N. LIS
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Credential | MSW, LCSW
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Telephone | 847-942-4920
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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 | 149012224
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License Number State | IL
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