Organization
RESTORE COUNSELING AND CONSULTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANDRA WILSON LPC (OWNER)
(601) 214-7464
Entity
Organization
Contact information
Practice address
4500 I 55 N STE 223, JACKSON, MS 39211-5931
(601) 214-7464
(601) 398-9493
Mailing address
4500 I 55 N STE 220, JACKSON, MS 39211-5931
(601) 214-7464
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
MS
Other
Enumeration date
08/18/2016
Last updated
11/13/2020
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