Provider Demographics
NPI:1013371293
Name:RESTORATION COUNSELING
Entity Type:Organization
Organization Name:RESTORATION COUNSELING
Other - Org Name:RESTORATION COUNSELING AND LIFE COACHING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:MOENNING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:904-412-2876
Mailing Address - Street 1:7545 CENTURION PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0579
Mailing Address - Country:US
Mailing Address - Phone:904-412-2876
Mailing Address - Fax:904-642-2469
Practice Address - Street 1:7545 CENTURION PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0579
Practice Address - Country:US
Practice Address - Phone:904-412-2876
Practice Address - Fax:904-642-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty