# BRAIN RESTORATION WELLNESS CENTER, LLC

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

## Provider details

- **NPI number:** 1871927483
- **Authorized official:** MARK DUREL (DIRECTOR)
- **Authorized official phone:** (985) 674-6650

## Contact information

- **Practice address:** 22532 HIGHWAY 1088, MANDEVILLE, LA 70448-8450
- **Practice address phone:** (985) 674-6650
- **Practice address fax:** (985) 674-4486
- **Mailing address:** 22532 HIGHWAY 1088, MANDEVILLE, LA 70448-8450
- **Mailing address phone:** (985) 674-6650
- **Mailing address fax:** (985) 674-4486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2013
- **Last updated:** 08/30/2013