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Organization
MINDFULLY RESTORED, LLC
Active
Organization
MINDFULLY RESTORED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANELLE SPENCER LCSW (OWNER)
(929) 277-7184
Entity
Organization
Contact information
Practice address
7835 74TH ST FL 2, GLENDALE, NY 11385-7427
(929) 277-7184
Mailing address
751 LINDEN BLVD, STE A PMB2051, BROOKLYN, NY 11203
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
101YS0200X
School Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
1041S0200X
School Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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