Provider Demographics
NPI:1972258085
Name:RESTORATIVE MINDS COUNSELING
Entity Type:Organization
Organization Name:RESTORATIVE MINDS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARKIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-364-9775
Mailing Address - Street 1:269 WALKER ST # 924
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4258
Mailing Address - Country:US
Mailing Address - Phone:313-364-9775
Mailing Address - Fax:
Practice Address - Street 1:3011 W GRAND BLVD STE 1507
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3000
Practice Address - Country:US
Practice Address - Phone:313-364-9775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)