Provider Demographics
NPI:1659123255
Name:RESTORATIVE COUNSELING AND LIFE COACHING
Entity Type:Organization
Organization Name:RESTORATIVE COUNSELING AND LIFE COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINATY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C
Authorized Official - Phone:240-447-5255
Mailing Address - Street 1:6907 DANFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4024
Mailing Address - Country:US
Mailing Address - Phone:240-447-5255
Mailing Address - Fax:
Practice Address - Street 1:6907 DANFORD DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4024
Practice Address - Country:US
Practice Address - Phone:240-447-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty