| Restore Wellness Counseling Llc | |
|
106 North Main Street Decatur IL 62523 | |
| (779) 220-0441 | |
| Not Available |
| Full Name | Restore Wellness Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 106 North Main Street, Decatur, Illinois |
| Authorized Official Name and Position | Nichele Deanne Hawbaker (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2179720744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Wellness Counseling Llc 106 N Main St Decatur IL 62523-1207 Ph: (779) 220-0441 | Restore Wellness Counseling Llc 106 North Main Street Decatur IL 62523 Ph: (779) 220-0441 |
| NPI Number | 1871117887 |
|---|---|
| Provider Enumeration Date | 06/04/2020 |
| Last Update Date | 10/30/2020 |
| Certification Date | 10/30/2020 |
| Medicare PECOS PAC ID | 7416367834 |
|---|---|
| Medicare Enrollment ID | O20201113000062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871117887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nichele D Hawbaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407097264 PECOS PAC ID: 5597810374 Enrollment ID: I20090831000299 |
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