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General NPI Number Information
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NPI Number | 1699342832
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Entity Type | Organization
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Legal Business Name | REVIVE HEALING & WELLNESS INSTITUTE, LLC.
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 970 SIDNEY MARCUS BLVD NE UNIT 1412
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City | ATLANTA
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State | GA
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Zip | 30324-3160
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Country | US
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Telephone | 404-500-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 970 SIDNEY MARCUS BLVD NE UNIT 1412
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City | ATLANTA
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State | GA
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Zip | 30324-3160
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Country | US
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Telephone | 404-500-9494
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MELISSA BAUMAN
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Credential | LMFT
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Telephone | 509-985-8788
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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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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