Provider Demographics
NPI:1700274172
Name:RESTORING LIVES COUNSELING & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:RESTORING LIVES COUNSELING & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EDLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THELUSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-814-3437
Mailing Address - Street 1:6151 MIRAMAR PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3972
Mailing Address - Country:US
Mailing Address - Phone:305-814-3437
Mailing Address - Fax:954-256-7386
Practice Address - Street 1:6151 MIRAMAR PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3972
Practice Address - Country:US
Practice Address - Phone:305-814-3437
Practice Address - Fax:954-256-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health