Organization
RELEASE TO RESTORE BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWANDA BENTON (ADMINISTRATOR)
(225) 317-9383
Entity
Organization
Contact information
Practice address
12090 S HARRELLS FERRY RD STE D2, BATON ROUGE, LA 70816-2470
(225) 317-9383
Mailing address
12090 S HARRELLS FERRY RD STE D2, BATON ROUGE, LA 70816-2470
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
471603617
IRS
LA
Enumeration date
08/09/2018
Last updated
08/09/2018
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