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General NPI Number Information
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NPI Number | 1811511934
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Entity Type | Organization
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Legal Business Name | LIFE RESTORATION COUNSELING SERVICES L.L.C.
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/06/2020
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Provider Practice Location Address
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Address Line | 2949 NEW BERN AVE STE 109
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City | RALEIGH
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State | NC
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Zip | 27610-1248
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Country | US
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Telephone | 919-307-9946
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Fax | 919-375-8921
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Provider Business Mailing Address
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Address Line | 1320 BALFOUR DOWNS CIR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-7763
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Country | US
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Telephone | 919-916-7663
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Fax | 919-375-8921
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY FELIPE RAINEY
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Credential | LCMHC
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Telephone | 919-916-7663
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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 |
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License Number State |
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