Provider Demographics
NPI:1568170298
Name:LIFE RESTORATION AND WELLNESS LLC
Entity Type:Organization
Organization Name:LIFE RESTORATION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-236-3990
Mailing Address - Street 1:1500 W WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3196
Mailing Address - Country:US
Mailing Address - Phone:906-236-3990
Mailing Address - Fax:
Practice Address - Street 1:1500 W WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3196
Practice Address - Country:US
Practice Address - Phone:906-236-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty