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General NPI Number Information
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NPI Number | 1346036209
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Entity Type | Organization
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Legal Business Name | REVIVIFY COUNSELING, LLC
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 43 CENTER ST STE 304
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3062
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Country | US
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Telephone | 413-337-0300
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Fax | 413-337-0370
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Provider Business Mailing Address
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Address Line | 161 NORTHAMPTON ST APT C
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City | EASTHAMPTON
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State | MA
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Zip | 01027-1059
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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 | OWNER/SOLO PROVIDER
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Name | NICOLE GAMACHE
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Credential | LMHC
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Telephone | 413-337-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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