Provider Demographics
NPI:1609263953
Name:FOUNDATION RESTORATION INC.
Entity Type:Organization
Organization Name:FOUNDATION RESTORATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCILWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFTA
Authorized Official - Phone:919-569-5820
Mailing Address - Street 1:9650 STRICKLAND RD
Mailing Address - Street 2:SUITE 103-180
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1902
Mailing Address - Country:US
Mailing Address - Phone:949-385-2711
Mailing Address - Fax:
Practice Address - Street 1:9370 FALLS OF NEUSE RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2487
Practice Address - Country:US
Practice Address - Phone:919-569-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1831106H00000X
NCLMFTA - 9080A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty