Provider Demographics
NPI:1639882806
Name:RESTORED OUTLOOK COUNSELING PLLC
Entity Type:Organization
Organization Name:RESTORED OUTLOOK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:SHONETTE
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-501-3771
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NC
Mailing Address - Zip Code:27806-0575
Mailing Address - Country:US
Mailing Address - Phone:252-514-7351
Mailing Address - Fax:
Practice Address - Street 1:75 GRIMES WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NC
Practice Address - Zip Code:27806-9063
Practice Address - Country:US
Practice Address - Phone:252-501-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty