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General NPI Number Information
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NPI Number | 1992579692
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Entity Type | Organization
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Legal Business Name | RESTORATION UNFOLDED
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 6837 40TH LN N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-6178
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Country | US
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Telephone | 813-431-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMANDA REBECCA BLACKWELL
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Credential | LCSW
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Telephone | 813-431-3203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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