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General NPI Number Information
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NPI Number | 1760323265
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Entity Type | Organization
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Legal Business Name | THE REVIVAL ROOM, LLC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 301 N SPRING ST STE 130
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City | BELLEFONTE
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State | PA
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Zip | 16823-1543
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Country | US
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Telephone | 814-343-1533
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Fax | 888-253-1993
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Provider Business Mailing Address
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Address Line | 301 N SPRING ST STE 130
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City | BELLEFONTE
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State | PA
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Zip | 16823-1543
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Country | US
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Telephone | 814-343-1533
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Fax | 888-253-1993
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JAYCIE JABCO
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Credential | LPC
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Telephone | 717-487-8857
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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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