Organization
RESTORE YOU COUNSELING AND CONSULTATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANNING CLARK (CEO, OWNER)
(301) 254-9608
Entity
Organization
Contact information
Practice address
6401 PIONEER DR, BALTIMORE, MD 21214-1092
(410) 564-6893
Mailing address
4812 CIRCLING HUNTER DR APT 202, COLUMBIA, MD 21045-5508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2011131
—
MD
Enumeration date
05/10/2019
Last updated
06/11/2019
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