Provider Demographics
NPI:1801452958
Name:RESTORATIVE PSYCHOTHERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:RESTORATIVE PSYCHOTHERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-650-4256
Mailing Address - Street 1:2301 BEACH HAVEN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1255
Mailing Address - Country:US
Mailing Address - Phone:757-568-5582
Mailing Address - Fax:
Practice Address - Street 1:3630 S PLAZA TRL STE 150A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3371
Practice Address - Country:US
Practice Address - Phone:757-568-5582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty