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General NPI Number Information
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NPI Number | 1821665191
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Entity Type | Organization
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Legal Business Name | REVIVE COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 480 PIERCE ST STE 108
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-262-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 480 PIERCE ST STE 108
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-262-4788
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRIAN COOK
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Credential | MS, NCC, LPC
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Telephone | 570-262-4788
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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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