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General NPI Number Information
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NPI Number | 1588909923
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Entity Type | Organization
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Legal Business Name | RESTORE COUNSELING & RECOVERY, INC.
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 7399 FOREST HILLS RD
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City | LOVES PARK
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State | IL
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Zip | 61111-3974
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Country | US
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Telephone | 815-708-7392
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Fax | 815-708-8248
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Provider Business Mailing Address
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Address Line | 7399 FOREST HILLS RD
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City | LOVES PARK
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State | IL
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Zip | 61111-3974
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Country | US
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Telephone | 815-708-7392
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Fax | 815-708-8248
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Authorized Official
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Title or Position | CEO
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Name | THOMAS G MLODZIK
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Credential | LCSW LMFT CRADC
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Telephone | 414-324-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 27402
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000729
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149012902
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License Number State | IL
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