Provider Demographics
NPI:1235528464
Name:RESTORATION PLACE MINISTRIES, INC.
Entity Type:Organization
Organization Name:RESTORATION PLACE MINISTRIES, INC.
Other - Org Name:RESTORATION PLACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-542-2060
Mailing Address - Street 1:PO BOX 35932
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27425-5932
Mailing Address - Country:US
Mailing Address - Phone:336-542-2060
Mailing Address - Fax:888-458-8020
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-542-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty