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General NPI Number Information
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NPI Number | 1639900822
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Entity Type | Organization
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Legal Business Name | RESTORATIVE MENTAL WELLNESS CENTER
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 14754 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48227-2941
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Country | US
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Telephone | 248-579-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 22777 HARPER AVE SUITE 207, PMB 2030
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City | ST. CLAIR SHORES
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State | MI
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Zip | 48080
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Country | US
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Telephone | 248-579-5560
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TASHARA COOPER
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Credential |
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Telephone | 248-579-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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