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General NPI Number Information
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NPI Number | 1699537944
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Entity Type | Organization
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Legal Business Name | REVIVE COUNSELING AND WELLNESS SERVICES
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 2615 6TH ST STE 8
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1727
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Country | US
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Telephone | 205-246-1656
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SOUTHVIEW LN STE 103-115
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City | TUSCALOOSA
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State | AL
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Zip | 35405-6390
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Country | US
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Telephone | 205-246-1656
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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 | KRYSTLE WHITE
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Credential | LPC
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Telephone | 205-246-1656
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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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