Restorer of Broken Walls PC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

RESTORER OF BROKEN WALLS PC

Practice address

644 Independence Parkway
Suite 200
Chesapeake, VA 23320

Phone

(757) 547-1811

Fax

(757) 547-1118

NPI assigned

Oct 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Amanda Bowers Grizzard, LPC LMFTNPI 1356432579

Title

Program Director

Phone

(757) 547-1811

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Willard, LPC

  • Professional Counselor
  • Norfolk, VA
  • NPI 1386717171
  Medicare reassignment NPD
• Amanda Bowers Grizzard, LPC LMFT

  • Professional Counselor
  • Chesapeake, VA
  • NPI 1356432579
  NPD Authorized official
• Laura Whisnant Sprinkle, LPC

  • Professional Counselor
  • Chesapeake, VA
  • NPI 1255166054
  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1811080047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 INDEPENDENCE PARKWAY",
            "address_2": "SUITE 200",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23320",
            "telephone_number": "757-547-1811",
            "fax_number": "757-547-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 INDEPENDENCE PARKWAY",
            "address_2": "SUITE 200",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23320",
            "telephone_number": "757-547-1811",
            "fax_number": "757-547-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORER OF BROKEN WALLS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-08-20",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "GRIZZARD",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "BOWERS",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "757-547-1811",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC LMFT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004944402",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.