Provider Demographics
NPI:1407466659
Name:RESTORATION COUNSELING OF SOUTH ALABAMA, LLC
Entity Type:Organization
Organization Name:RESTORATION COUNSELING OF SOUTH ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPC, BC-TMH
Authorized Official - Phone:251-656-8036
Mailing Address - Street 1:5270 RODGERS RD
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-9136
Mailing Address - Country:US
Mailing Address - Phone:251-656-8036
Mailing Address - Fax:205-839-8330
Practice Address - Street 1:1120 HILLCREST RD STE 2G
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3955
Practice Address - Country:US
Practice Address - Phone:251-656-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty