Provider Demographics
NPI:1750714382
Name:RESTORATIVE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:RESTORATIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-884-7517
Mailing Address - Street 1:12020 SUNRISE VALLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3429
Mailing Address - Country:US
Mailing Address - Phone:703-884-7517
Mailing Address - Fax:
Practice Address - Street 1:12020 SUNRISE VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3429
Practice Address - Country:US
Practice Address - Phone:703-884-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4739101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK37OtherCARE FIRST
MD0591041 00Medicaid