Provider Demographics
NPI:1669065645
Name:RESTORATIVE PSYCHOTHERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:RESTORATIVE PSYCHOTHERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NETSANET
Authorized Official - Middle Name:ABRAHA
Authorized Official - Last Name:TEGEGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-568-5582
Mailing Address - Street 1:2301 BEACH HAVEN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1255
Mailing Address - Country:US
Mailing Address - Phone:615-506-8362
Mailing Address - Fax:757-578-8237
Practice Address - Street 1:4235 HILLSBORO PIKE STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3344
Practice Address - Country:US
Practice Address - Phone:757-568-5582
Practice Address - Fax:757-578-8237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1801452958
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty