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General NPI Number Information
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NPI Number | 1336558204
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Entity Type | Organization
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Legal Business Name | REVIVE COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 750 HAMMOND DR BUILDING 4, SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-590-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 750 HAMMOND DR BUILDING 4, SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-590-6005
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | LAUREN BAKER
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Credential | M.A., LMFT, LPC
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Telephone | 404-590-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007169
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001272
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License Number State | GA
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