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General NPI Number Information
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NPI Number | 1821897513
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Entity Type | Organization
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Legal Business Name | RESTART COLLECTIVE
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 151 E MAIN ST
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City | KINGSPORT
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State | TN
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Zip | 37660-4379
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Country | US
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Telephone | 423-677-3023
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Fax | 423-378-3216
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Provider Business Mailing Address
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Address Line | 151 E MAIN ST
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City | KINGSPORT
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State | TN
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Zip | 37660-4379
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Country | US
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Telephone | 423-677-3023
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS THOMAS BOWEN
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Credential |
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Telephone | 423-677-3023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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