Healthcare Provider Details

I. General information

NPI: 1477468379
Provider Name (Legal Business Name): RAISE AND REVIVE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CENTRAL AVE STE 1000
PHOENIX AZ
85004-1027
US

IV. Provider business mailing address

2828 N CENTRAL AVE STE 1000
PHOENIX AZ
85004-1027
US

V. Phone/Fax

Practice location:
  • Phone: 785-861-0404
  • Fax: 785-861-0404
Mailing address:
  • Phone: 785-861-0404
  • Fax: 785-861-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL N WHITE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 785-861-0404