| Restoration Counseling And Support Services, Llc | |
|
2255 Dunn Ave Ste 206 Jacksonville FL 32218-4739 | |
| (904) 453-7970 | |
| Not Available |
| Full Name | Restoration Counseling And Support Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2255 Dunn Ave Ste 206, Jacksonville, Florida |
| Authorized Official Name and Position | Kandi Jackson (OWNER) |
| Authorized Official Contact | 9044537970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration Counseling And Support Services, Llc 5836 Copper Creek Dr Jacksonville FL 32218-7334 Ph: (904) 710-0625 | Restoration Counseling And Support Services, Llc 2255 Dunn Ave Ste 206 Jacksonville FL 32218-4739 Ph: (904) 453-7970 |
| NPI Number | 1629547989 |
|---|---|
| Provider Enumeration Date | 11/15/2018 |
| Last Update Date | 11/01/2020 |
| Certification Date | 11/01/2020 |
| Medicare PECOS PAC ID | 9931440351 |
|---|---|
| Medicare Enrollment ID | O20190412001448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629547989 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kandi Jolene Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467955567 PECOS PAC ID: 0840531265 Enrollment ID: I20190424000192 |
| Provider Name | Brianna Pemberton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366987133 PECOS PAC ID: 7315314499 Enrollment ID: I20221102001039 |
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