Provider Demographics
NPI:1255094074
Name:RESTORE COUNSELING SERVICES
Entity Type:Organization
Organization Name:RESTORE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNETTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER- KENNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-385-0066
Mailing Address - Street 1:12762 SW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2503
Mailing Address - Country:US
Mailing Address - Phone:305-389-2626
Mailing Address - Fax:
Practice Address - Street 1:12762 SW 184TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2503
Practice Address - Country:US
Practice Address - Phone:305-385-0066
Practice Address - Fax:305-468-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)