Organization
RESTORE U INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ISLAINE ST.VIL MSW,LCSW (LICENSED CLINICAL SOCIAL WORKER)
(813) 495-6702
Entity
Organization
Contact information
Practice address
3005 LITHIA PINECREST RD, VALRICO, FL 33596-5630
(813) 495-6702
(813) 425-5739
Mailing address
3005 LITHIA PINECREST RD, VALRICO, FL 33596-5630
(813) 495-6702
(813) 425-5739
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SW 13121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017869000
—
FL
Enumeration date
01/16/2017
Last updated
01/16/2017
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