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General NPI Number Information
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NPI Number | 1700544350
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Entity Type | Organization
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Legal Business Name | REVITALIZE COUNSELING, PLLC
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 431 WATERVILLE RD
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City | REALEIGH
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State | NC
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Zip | 27603
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Country | US
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Telephone | 919-357-8832
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Fax | 919-336-5134
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Provider Business Mailing Address
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Address Line | 1220 TIMBER DR E # 1033
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City | GARNER
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State | NC
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Zip | 27529-6917
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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
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Name | ASHLEY CRAFT
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Credential | LCSW
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Telephone | 919-357-8832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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