Provider Demographics
NPI:1578104329
Name:W. RENEE MARTIN LICENSED CLINICAL SOCIAL WORKER
Entity Type:Organization
Organization Name:W. RENEE MARTIN LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:RESTORED WELLNESS COUNSEILNG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WYNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-400-0505
Mailing Address - Street 1:8788 ELK GROVE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1767
Mailing Address - Country:US
Mailing Address - Phone:916-400-0505
Mailing Address - Fax:
Practice Address - Street 1:8788 ELK GROVE BLVD STE D
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1767
Practice Address - Country:US
Practice Address - Phone:916-400-0505
Practice Address - Fax:916-848-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty