Provider Demographics
NPI:1053944074
Name:RESTORATIVE COUNSELING & CONSULTATION, A CLINICAL SOCIAL WORK CORPORAT
Entity type:Organization
Organization Name:RESTORATIVE COUNSELING & CONSULTATION, A CLINICAL SOCIAL WORK CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-329-8463
Mailing Address - Street 1:3022 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2541
Mailing Address - Country:US
Mailing Address - Phone:510-329-8463
Mailing Address - Fax:877-346-7602
Practice Address - Street 1:4126 TELEGRAPH AVE.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-9460
Practice Address - Country:US
Practice Address - Phone:510-686-3116
Practice Address - Fax:877-346-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134164726OtherINDIVIDUAL