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General NPI Number Information
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NPI Number | 1700394715
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Entity Type | Organization
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Legal Business Name | RESTART COUNSELING PLLC
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 1625 N 4TH ST STE 102C
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City | COEUR D ALENE
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State | ID
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Zip | 83814-6178
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Country | US
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Telephone | 208-930-4383
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 N 4TH ST STE 102C
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City | COEUR D ALENE
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State | ID
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Zip | 83814-6178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ANGELA HOLLAND
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Credential |
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Telephone | 208-930-4383
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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 |
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License Number State |
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