Provider Demographics
NPI:1043661143
Name:RESTORATION FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:RESTORATION FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-330-7904
Mailing Address - Street 1:313 KENDAL STREET SUITE B
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688
Mailing Address - Country:US
Mailing Address - Phone:707-330-7904
Mailing Address - Fax:888-356-3203
Practice Address - Street 1:313 KENDAL STREET SUITE B
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688
Practice Address - Country:US
Practice Address - Phone:707-330-7904
Practice Address - Fax:888-356-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92236106H00000X
CA25589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty