Provider Demographics
NPI:1811389794
Name:RESET & RESTART, LLC
Entity Type:Organization
Organization Name:RESET & RESTART, LLC
Other - Org Name:RESET & RESTART MENTAL HEALTH & WELLNESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:860-706-7592
Mailing Address - Street 1:701 COTTAGE GROVE RD STE A230
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3084
Mailing Address - Country:US
Mailing Address - Phone:860-706-7592
Mailing Address - Fax:
Practice Address - Street 1:701 COTTAGE GROVE RD STE A230
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3084
Practice Address - Country:US
Practice Address - Phone:860-706-7592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT187695384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty