Provider Demographics
NPI:1831883131
Name:RESTORATION COUNSELING CENTER
Entity type:Organization
Organization Name:RESTORATION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-350-9660
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72089-0277
Mailing Address - Country:US
Mailing Address - Phone:501-350-9660
Mailing Address - Fax:
Practice Address - Street 1:209 ROYA LN STE 4
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2669
Practice Address - Country:US
Practice Address - Phone:501-350-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty