Provider Demographics
NPI:1548023773
Name:A RESTORED MIND PLLC
Entity type:Organization
Organization Name:A RESTORED MIND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NEUROFEEDBACK CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, BCN
Authorized Official - Phone:336-480-7623
Mailing Address - Street 1:474 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-9014
Mailing Address - Country:US
Mailing Address - Phone:336-480-7623
Mailing Address - Fax:
Practice Address - Street 1:474 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9014
Practice Address - Country:US
Practice Address - Phone:336-480-7623
Practice Address - Fax:336-899-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health