Provider Demographics
NPI:1689150864
Name:URBAN RESTORATION COUNSELING CENTER
Entity Type:Organization
Organization Name:URBAN RESTORATION COUNSELING CENTER
Other - Org Name:SHANELLE D. JOHNSON
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-343-9543
Mailing Address - Street 1:7317 EL CAJON BLVD # 129
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7434
Mailing Address - Country:US
Mailing Address - Phone:619-343-9543
Mailing Address - Fax:619-713-2561
Practice Address - Street 1:7317 EL CAJON BLVD # 129
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7434
Practice Address - Country:US
Practice Address - Phone:619-343-9543
Practice Address - Fax:619-713-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty