Provider Demographics
NPI:1689243305
Name:RESTORATIVE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-237-6950
Mailing Address - Street 1:200 N MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2354
Mailing Address - Country:US
Mailing Address - Phone:604-617-7928
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:200 N MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2354
Practice Address - Country:US
Practice Address - Phone:860-461-7792
Practice Address - Fax:508-433-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty