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Organization
RESTORE MENTAL WELLNESS, LICENSED CLINICAL SOCIAL WORKER, INC
Active
Organization
RESTORE MENTAL WELLNESS, LICENSED CLINICAL SOCIAL WORKER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANITZA MEDINA LCSW (CEO)
(562) 556-1312
Entity
Organization
Contact information
Practice address
22521 SCARLET SAGE WAY, MORENO VALLEY, CA 92557-5921
(562) 556-1312
Mailing address
13502 WHITTIER BLVD # H232, WHITTIER, CA 90605-1945
(562) 556-1312
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902064074
—
CA
Enumeration date
02/10/2025
Last updated
02/10/2025
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