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General NPI Number Information
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NPI Number | 1710784319
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Entity Type | Organization
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Legal Business Name | URBAN RESTORATION COUNSELING CENTER
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1925 EUCLID AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-5361
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Country | US
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Telephone | 619-648-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 LOU ST
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3141
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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 | LMFT, CO-FOUNDER
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Name | SHANELLE JOHNSON
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Credential | LMFT
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Telephone | 619-219-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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