Provider Demographics
NPI:1821897513
Name:RESTART COLLECTIVE
Entity type:Organization
Organization Name:RESTART COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-677-3023
Mailing Address - Street 1:151 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4379
Mailing Address - Country:US
Mailing Address - Phone:423-677-3023
Mailing Address - Fax:
Practice Address - Street 1:151 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4379
Practice Address - Country:US
Practice Address - Phone:423-677-3023
Practice Address - Fax:423-378-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health