Provider Demographics
NPI:1710784319
Name:URBAN RESTORATION COUNSELING CENTER
Entity type:Organization
Organization Name:URBAN RESTORATION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT, CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-219-4260
Mailing Address - Street 1:3412 LOU ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5361
Practice Address - Country:US
Practice Address - Phone:619-648-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)