Provider Demographics
NPI:1629733571
Name:RESTORATION COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:RESTORATION COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:SELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-731-2787
Mailing Address - Street 1:18367 PIERRE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1257
Mailing Address - Country:US
Mailing Address - Phone:248-461-7067
Mailing Address - Fax:
Practice Address - Street 1:269 WALKER ST # 422
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4258
Practice Address - Country:US
Practice Address - Phone:313-731-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)