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General NPI Number Information
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NPI Number | 1639003775
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Entity Type | Organization
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Legal Business Name | REVISE COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 5324 MACCORKLE AVE SE STE A
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City | CHARLESTON
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State | WV
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Zip | 25304-2200
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Country | US
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Telephone | 304-205-1988
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4041
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City | CHARLESTON
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State | WV
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Zip | 25364-4041
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Country | US
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Telephone | 304-205-1988
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY MASON
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Credential | PHD, LPC, ALPS
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Telephone | 304-205-1988
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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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