Provider Demographics
NPI:1265015911
Name:RESTORE COUNSELING CENTER
Entity Type:Organization
Organization Name:RESTORE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-906-0918
Mailing Address - Street 1:103 LOCKHARTS LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-6100
Mailing Address - Country:US
Mailing Address - Phone:610-906-0918
Mailing Address - Fax:
Practice Address - Street 1:103 LOCKHARTS LN
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-6100
Practice Address - Country:US
Practice Address - Phone:610-906-0918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty