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General NPI Number Information
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NPI Number | 1811389794
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Entity Type | Organization
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Legal Business Name | RESET & RESTART, LLC
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 701 COTTAGE GROVE RD STE A230
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3084
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Country | US
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Telephone | 860-706-7592
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Fax |
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Provider Business Mailing Address
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Address Line | 701 COTTAGE GROVE RD STE A230
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3084
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Country | US
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Telephone | 860-706-7592
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENESHA NICHOLS
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Credential | DSW
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Telephone | 860-706-7592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 187695384
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License Number State | CT
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