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General NPI Number Information
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NPI Number | 1780142554
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Entity Type | Organization
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Legal Business Name | REVIVING EMOTIONAL STRENGTH, LLC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 2775 CRUSE RD STE 102
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7141
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Country | US
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Telephone | 678-524-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 OPIE LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2737
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Country | US
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Telephone | 678-524-4688
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAMIANA ONI
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Credential | LCSW
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Telephone | 678-524-4688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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