Provider Demographics
NPI:1811417587
Name:RESTORED HOPE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:RESTORED HOPE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:QUEENIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-219-5892
Mailing Address - Street 1:108 MAIN AVENUE, SW
Mailing Address - Street 2:SUITE 903
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481
Mailing Address - Country:US
Mailing Address - Phone:330-219-5892
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN AVE SW STE 903
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1010
Practice Address - Country:US
Practice Address - Phone:330-219-5892
Practice Address - Fax:234-600-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700418SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty