Organization Active NPI

Restored Hope Counseling Services LLC

  • Professional Counselor
  • Warren, OH
National Provider Identifier
1811417587
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E0700418SUPV Issued in OH
Legal business name
RESTORED HOPE COUNSELING SERVICES LLC
Practice address
108 Main Ave SW Ste 903
Warren, OH 44481-1010
Phone
(330) 219-5892
Fax
(234) 600-5564
NPI assigned
Jun 23, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Queenie V Lathan, LPCC-SNPI 1124259122
Title
Clinical Counselor
Phone
(330) 219-5892

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E0700418SUPV OH Primary

Addresses

Primary practice location

108 Main Ave SW Ste 903
Warren, OH 44481-1010

Mailing address

108 Main Avenue, SW
Suite 903
Warren, OH 44481
Phone (330) 219-5892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211110000202 OH Part B Supplier - Clinic/Group Practice 6103215330 Receives reassigned benefits from 2 practitioners
Practice locations: Warren, OH

National Provider Directory

National Provider Directory

Locations

108 Main Ave SW
Ste 903
Warren, OH 44481
Phone (234) 830-0047

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1811417587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 MAIN AVENUE, SW",
            "address_2": "SUITE 903",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "44481",
            "telephone_number": "330-219-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MAIN AVE SW STE 903",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444811010",
            "telephone_number": "330-219-5892",
            "fax_number": "234-600-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORED HOPE COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LATHAN",
        "authorized_official_first_name": "QUEENIE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CLINICAL COUNSELOR",
        "authorized_official_telephone_number": "330-219-5892",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPCC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0700418SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.