| 4 2 Restore, Llc | |
|
8310 Liberty Rd Ste 2c Windsor Mill MD 21244-3124 | |
| (443) 500-4887 | |
| Not Available |
| Full Name | 4 2 Restore, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 8310 Liberty Rd Ste 2c, Windsor Mill, Maryland |
| Authorized Official Name and Position | Deadra M Martin (OWNER/PROGRAM COORDINATOR) |
| Authorized Official Contact | 4435004887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 4 2 Restore, Llc 3527 N Rolling Rd Ste 4 Windsor Mill MD 21244-2256 Ph: (443) 500-4887 | 4 2 Restore, Llc 8310 Liberty Rd Ste 2c Windsor Mill MD 21244-3124 Ph: (443) 500-4887 |
| NPI Number | 1912401183 |
|---|---|
| Provider Enumeration Date | 03/21/2018 |
| Last Update Date | 06/10/2020 |
| Certification Date | 06/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912401183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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