Provider Demographics
NPI:1114543923
Name:RESTORATIVE THERAPY AND CONSULTING LLC
Entity Type:Organization
Organization Name:RESTORATIVE THERAPY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-375-3043
Mailing Address - Street 1:1 HUNTINGTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7206
Mailing Address - Country:US
Mailing Address - Phone:404-375-3043
Mailing Address - Fax:706-543-4458
Practice Address - Street 1:1 HUNTINGTON RD STE 204
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7206
Practice Address - Country:US
Practice Address - Phone:404-375-3043
Practice Address - Fax:706-543-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty