Provider Demographics
NPI:1235491507
Name:RESTORING BODIES AND MINDS, LLC
Entity Type:Organization
Organization Name:RESTORING BODIES AND MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:SHAVONE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:252-820-0652
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:TOWNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27584-0101
Mailing Address - Country:US
Mailing Address - Phone:919-529-2215
Mailing Address - Fax:919-529-2239
Practice Address - Street 1:2555 CAPITOL DR STE E4
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-7398
Practice Address - Country:US
Practice Address - Phone:919-529-2215
Practice Address - Fax:919-529-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-039-055251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health