Healthcare Provider Details

I. General information

NPI: 1871909689
Provider Name (Legal Business Name): REVELATION OF HOPE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 CARRIAGE HOUSE DR STE C
JACKSON TN
38305-2268
US

IV. Provider business mailing address

PO BOX 934
HUMBOLDT TN
38343-0934
US

V. Phone/Fax

Practice location:
  • Phone: 731-868-7297
  • Fax: 877-273-4824
Mailing address:
  • Phone: 731-487-3595
  • Fax: 877-273-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2865
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2865
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number990
License Number StateTN

VIII. Authorized Official

Name: ALVIN G. BONDS II
Title or Position: OWNER & CLINICAL DIRECTOR
Credential:
Phone: 731-868-7297