Organization
4 2 RESTORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEADRA MONIQUE MARTIN (PROGRAM DIRECTOR/OWNER)
(443) 500-4887
Entity
Organization
Contact information
Practice address
3527 N ROLLING RD STE 4, WINDSOR MILL, MD 21244-2256
(410) 701-9190
(410) 701-7483
Mailing address
3527 N ROLLING RD STE 4, WINDSOR MILL, MD 21244-2256
(410) 701-9190
(410) 701-7483
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/15/2018
Last updated
10/13/2020
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