Healthcare Provider Details

I. General information

NPI: 1164269213
Provider Name (Legal Business Name): REVIVING SOLUTIONS & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 ROYAL HEIGHTS DR
CINCINNATI OH
45239-4245
US

IV. Provider business mailing address

11711 PRINCETON PIKE STE 341-143
CINCINNATI OH
45246-2534
US

V. Phone/Fax

Practice location:
  • Phone: 513-334-6539
  • Fax:
Mailing address:
  • Phone: 937-502-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CIERRA JACKSON
Title or Position: CEO
Credential: LPCC-S, LICDC
Phone: 937-502-5037