Provider Demographics
NPI:1861154023
Name:RESTORATIVE HOPE SANCTUARY PLLC
Entity type:Organization
Organization Name:RESTORATIVE HOPE SANCTUARY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-987-0405
Mailing Address - Street 1:1309 WINKLER AVE APT 628
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6489
Mailing Address - Country:US
Mailing Address - Phone:254-987-0405
Mailing Address - Fax:
Practice Address - Street 1:1615 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-3009
Practice Address - Country:US
Practice Address - Phone:255-498-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty