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General NPI Number Information
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NPI Number | 1639615537
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Entity Type | Organization
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Legal Business Name | RESTORE U INC.
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 3005 LITHIA PINECREST RD
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City | VALRICO
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State | FL
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Zip | 33596-5630
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Country | US
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Telephone | 813-495-6702
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Fax | 813-425-5739
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Provider Business Mailing Address
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Address Line | 3005 LITHIA PINECREST RD
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City | VALRICO
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State | FL
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Zip | 33596-5630
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Country | US
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Telephone | 813-495-6702
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Fax | 813-425-5739
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. ISLAINE ST.VIL
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Credential | MSW,LCSW
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Telephone | 813-495-6702
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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 | SW 13121
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License Number State | FL
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