# RESTORE LIFE SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306376322
- **Authorized official:** LEFAWN SPEIGHT (CLINICAL DIRECTOR/THERAPIST)
- **Authorized official phone:** (301) 628-6140

## Contact information

- **Practice address:** 4625 G ST SE, WASHINGTON, DC 20019-7834
- **Practice address phone:** (301) 628-6140
- **Mailing address:** 12813 LAMPTON LN, FORT WASHINGTON, MD 20744-5314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | NULL | — |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 06/13/2017
- **Last updated:** 06/13/2017