Provider Demographics
NPI:1295214112
Name:RESTORE COUNSELING, LLC
Entity Type:Organization
Organization Name:RESTORE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:RZENGOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:703-397-3124
Mailing Address - Street 1:10301 DEMOCRACY LN STE 275
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2525
Mailing Address - Country:US
Mailing Address - Phone:703-397-3124
Mailing Address - Fax:703-539-0004
Practice Address - Street 1:10301 DEMOCRACY LN STE 275
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2525
Practice Address - Country:US
Practice Address - Phone:845-321-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007802261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)