Provider Demographics
NPI:1811511934
Name:LIFE RESTORATION COUNSELING SERVICES L.L.C.
Entity type:Organization
Organization Name:LIFE RESTORATION COUNSELING SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-916-7663
Mailing Address - Street 1:1320 BALFOUR DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7763
Mailing Address - Country:US
Mailing Address - Phone:919-916-7663
Mailing Address - Fax:919-375-8921
Practice Address - Street 1:2949 NEW BERN AVE STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-307-9946
Practice Address - Fax:919-375-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty