Provider Demographics
NPI:1588909923
Name:RESTORE COUNSELING & RECOVERY, INC.
Entity type:Organization
Organization Name:RESTORE COUNSELING & RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MLODZIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LMFT CRADC
Authorized Official - Phone:414-324-9332
Mailing Address - Street 1:7399 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3974
Mailing Address - Country:US
Mailing Address - Phone:815-708-7392
Mailing Address - Fax:815-708-8248
Practice Address - Street 1:7399 FOREST HILLS RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3974
Practice Address - Country:US
Practice Address - Phone:815-708-7392
Practice Address - Fax:815-708-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL27402101YA0400X
IL166000729106H00000X
IL1490129021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty