Organization
RESTORE ADDICTION RECOVERY AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS L WATSON LPC, SAP, MAC (EXECUTIVE DIRECTOR)
(724) 825-5527
Entity
Organization
Contact information
Practice address
613 BURROUGHS ST, MORGANTOWN, WV 26505-3332
(724) 825-5527
Mailing address
613 BURROUGHS ST, MORGANTOWN, WV 26505-3332
(724) 825-5527
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170
STATE OF WV
WV
Enumeration date
01/31/2022
Last updated
10/11/2022
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