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General NPI Number Information
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NPI Number | 1801452958
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Entity Type | Organization
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Legal Business Name | RESTORATIVE PSYCHOTHERAPY & WELLNESS LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 3630 S PLAZA TRL STE 150A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3371
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Country | US
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Telephone | 757-568-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 BEACH HAVEN DR APT 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1255
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Country | US
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Telephone | 757-568-5582
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CHERYL TANT
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Credential |
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Telephone | 757-650-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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