| Restore And Recover Counseling Llc | |
|
14074 Trade Center Dr Ste 220 Fishers IN 46038-4575 | |
| (317) 775-7797 | |
| Not Available |
| Full Name | Restore And Recover Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 14074 Trade Center Dr Ste 220, Fishers, Indiana |
| Authorized Official Name and Position | Nicole Marie Liedtke (OWNER) |
| Authorized Official Contact | 3177757797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore And Recover Counseling Llc 14074 Trade Center Dr Ste 220 Fishers IN 46038-4575 Ph: (317) 775-7797 | Restore And Recover Counseling Llc 14074 Trade Center Dr Ste 220 Fishers IN 46038-4575 Ph: (317) 775-7797 |
| NPI Number | 1417553793 |
|---|---|
| Provider Enumeration Date | 12/10/2020 |
| Last Update Date | 12/10/2020 |
| Certification Date | 12/10/2020 |
| Medicare PECOS PAC ID | 8426460445 |
|---|---|
| Medicare Enrollment ID | O20201216001962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417553793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nicole Marie Liedtke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740505460 PECOS PAC ID: 2163691817 Enrollment ID: I20110815000120 |
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