Organization
RESTORER OF BROKEN WALLS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA BOWERS GRIZZARD LPC LMFT (PROGRAM DIRECTOR)
(757) 547-1811
Entity
Organization
Contact information
Practice address
644 INDEPENDENCE PARKWAY, SUITE 200, CHESAPEAKE, VA 23320
(757) 547-1811
(757) 547-1118
Mailing address
644 INDEPENDENCE PARKWAY, SUITE 200, CHESAPEAKE, VA 23320
(757) 547-1811
(757) 547-1118
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004944402
—
VA
Enumeration date
10/02/2006
Last updated
08/20/2024
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