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General NPI Number Information
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NPI Number | 1356702161
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Entity Type | Organization
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Legal Business Name | REVELATION COUNSELING CENTER
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 1040 S PRESTON ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2763
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Country | US
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Telephone | 502-224-4478
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 S PRESTON ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2763
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Country | US
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Telephone | 502-224-4478
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/LEAD THERAPIST/OWNER
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Name | MRS. LA'SHONDA NICOLE FLETCHER
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Credential | LMFTA
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Telephone | 502-224-4478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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