Provider Demographics
NPI:1083304299
Name:REVIVE COUNSELING, PLLC
Entity Type:Organization
Organization Name:REVIVE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:253-268-9448
Mailing Address - Street 1:225 N BENNETT ST STE H
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4810
Mailing Address - Country:US
Mailing Address - Phone:253-268-9448
Mailing Address - Fax:
Practice Address - Street 1:225 N BENNETT ST STE H
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4810
Practice Address - Country:US
Practice Address - Phone:253-268-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty