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Organization

4 2 RESTORE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DEADRA M MARTIN PHD (OWNER/PROGRAM COORDINATOR)
(443) 500-4887
Entity
Organization

Contact information

Practice address
8310 LIBERTY RD STE 2C, WINDSOR MILL, MD 21244-3124
(443) 500-4887
Mailing address
3527 N ROLLING RD STE 4, WINDSOR MILL, MD 21244-2256
(443) 500-4887

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Enumeration date
03/21/2018
Last updated
06/10/2020
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