Provider Demographics
NPI:1093082844
Name:REVELATIONS COUNSELING CENTER
Entity Type:Organization
Organization Name:REVELATIONS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED CLINICAL PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-293-7100
Mailing Address - Street 1:128 LOFTON ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 LOFTON ST
Practice Address - Street 2:STE. 300
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2198
Practice Address - Country:US
Practice Address - Phone:972-293-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX066211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty