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General NPI Number Information
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NPI Number | 1295644367
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Entity Type | Organization
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Legal Business Name | REVIVE HOPE & WELLNESS LLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 119 WESTMONT DR
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City | WATERBURY
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State | CT
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Zip | 06708-2400
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Country | US
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Telephone | 203-508-5069
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Fax |
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Provider Business Mailing Address
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Address Line | 544 STRAITS TPKE STE 3
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City | WATERTOWN
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State | CT
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Zip | 06795-3340
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Country | US
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Telephone | 203-723-3468
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Fax |
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Authorized Official
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Title or Position | OWNER/ COUNCELOR
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Name | MRS. VENESA WHITE
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Credential | LPC
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Telephone | 203-508-5069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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