=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770378812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORED CHRISTIAN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 THAYER CTR STE COAKLAND
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-230-7724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 204
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20659-0204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-230-7724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR & CLINICIAN
-----------------------------------------------------
Name | LUKE JOHANNI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-376-0633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------