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General NPI Number Information
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NPI Number | 1851896609
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Entity Type | Organization
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Legal Business Name | REVELATION COUNSELING, LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 199 OAKWOOD AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2150
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Country | US
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Telephone | 206-819-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 29 GOODSELL ST
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1128
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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 | CEO
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Name | KAREEM AYODEJI
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Credential | LCSW
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Telephone | 206-819-8258
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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 | 009981
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License Number State | CT
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