Provider Demographics
NPI:1215541446
Name:RESTORE, BALANCE, AND WELLNESS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:RESTORE, BALANCE, AND WELLNESS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:443-783-6920
Mailing Address - Street 1:1099 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-8019
Mailing Address - Country:US
Mailing Address - Phone:443-783-6920
Mailing Address - Fax:
Practice Address - Street 1:1099 DAVIS RD
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-8019
Practice Address - Country:US
Practice Address - Phone:443-783-6920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty