Provider Demographics
NPI:1255059051
Name:MAHOGANY RESTORATIVE COUNSELING, LLC
Entity type:Organization
Organization Name:MAHOGANY RESTORATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:980-200-5978
Mailing Address - Street 1:470 W BROAD ST # 1155
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2759
Mailing Address - Country:US
Mailing Address - Phone:614-992-3525
Mailing Address - Fax:
Practice Address - Street 1:2303 MEADOW VILLAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4913
Practice Address - Country:US
Practice Address - Phone:980-200-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty