Organization
RESTORE LIFE BEHAVIORAL HEALTH
Active
Organization
RESTORE LIFE BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERVETTA PORTER MA, LPC (OWNER)
(615) 348-5806
Entity
Organization
Contact information
Practice address
100 COUNTRY CLUB DR STE 200, HENDERSONVILLE, TN 37075
(615) 348-5806
(615) 285-8130
Mailing address
100 COUNTRY CLUB DR STE 200, HENDERSONVILLE, TN 37075-4376
(615) 348-5806
(615) 285-8130
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3685
TN
1041C0700X
Clinical Social Worker
6289
TN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
3685
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q027516
—
TN
Enumeration date
08/20/2018
Last updated
09/03/2019
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