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General NPI Number Information
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NPI Number | 1093082844
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Entity Type | Organization
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Legal Business Name | REVELATIONS COUNSELING CENTER
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 128 LOFTON ST STE. 300
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City | CEDAR HILL
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State | TX
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Zip | 75104-2198
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Country | US
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Telephone | 972-293-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 128 LOFTON ST STE. 300
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City | CEDAR HILL
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State | TX
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Zip | 75104-2198
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADVANCED CLINICAL PRACTITIONER
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Name | MS. SANDRA E JONES
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Credential | LCSW
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Telephone | 972-293-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06621
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License Number State | TX
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