Provider Demographics
NPI:1992289474
Name:RESTORE LIFE PLC
Entity type:Organization
Organization Name:RESTORE LIFE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASIINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:734-234-6688
Mailing Address - Street 1:18600 NORTHVILLE RD STE 400A
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3544
Mailing Address - Country:US
Mailing Address - Phone:734-234-6688
Mailing Address - Fax:
Practice Address - Street 1:18600 NORTHVILLE RD STE 400A
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:734-234-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty