Restore Addiction Recovery and Wellness LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

RESTORE ADDICTION RECOVERY AND WELLNESS LLC

Practice address

613 Burroughs St
Morgantown, WV 26505-3332

Phone

(724) 825-5527

NPI assigned

Jan 31, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Travis L Watson, LPC, SAP, MAC

Title

Executive Director

Phone

(724) 825-5527

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1144973116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 BURROUGHS ST",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265053332",
            "telephone_number": "724-825-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 BURROUGHS ST",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265053332",
            "telephone_number": "724-825-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE ADDICTION RECOVERY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-825-5527",
        "authorized_official_credential": "LPC, SAP, MAC"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WV",
            "identifier": "170",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "restoreaddictionwellness@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Company email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "613 Burroughs St",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265053332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Roger Renner, RPH, MBA
• Renner'S Pharmacy
• Richard Anton Renquest Jr., MA, LPC, NCC, ALPS
• Shaniela Reseter
• Holly Ressetar
• Joseph C Rettig, M.D.
• Dana Leann Reynolds
• Gorman Joel Reynolds, M.D.
• Joanna Lyn Reynolds, NNP-BC
• Michael Reynolds, MD

• Addiction Medicine (Family Medicine) Physician in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Addiction Medicine (Family Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.