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General NPI Number Information
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NPI Number | 1669105490
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Entity Type | Organization
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Legal Business Name | RESTORATION TREATMENT CENTER OF TEXAS, LLC
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 4425 PLANO PKWY STE 601
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City | CARROLLTON
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State | TX
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Zip | 75010-5030
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Country | US
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Telephone | 682-445-0431
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Fax |
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Provider Business Mailing Address
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Address Line | 3827 TARRANT MAIN ST
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City | EULESS
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State | TX
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Zip | 76040-7214
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Country | US
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Telephone | 601-594-8048
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LABORIS COLE
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Credential | PHD
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Telephone | 601-594-8048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 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 #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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