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General NPI Number Information
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NPI Number | 1720705825
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Entity Type | Organization
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Legal Business Name | REVIRESCO COUNSELING, LLC
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 104 EAST PARK DRIVE BUILDING 300
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-538-5830
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Fax | 949-404-6194
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Provider Business Mailing Address
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Address Line | 104 EAST PARK DRIVE BUILDING 300
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-538-5830
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Fax | 949-404-6194
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Authorized Official
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Title or Position | OWNER
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Name | SARAH LYNN WENDELL
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Credential | LPC-MHSP
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Telephone | 615-538-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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