Provider Demographics
NPI:1033858477
Name:HEAL AND RESTORE, PLLC
Entity Type:Organization
Organization Name:HEAL AND RESTORE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-315-4421
Mailing Address - Street 1:4830 LAKE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-8316
Mailing Address - Country:US
Mailing Address - Phone:252-696-4091
Mailing Address - Fax:929-290-0328
Practice Address - Street 1:2270 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1729
Practice Address - Country:US
Practice Address - Phone:252-696-4091
Practice Address - Fax:929-290-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty