Provider Demographics
NPI:1275299836
Name:REVIVE COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:REVIVE COUNSELING AND CONSULTING LLC
Other - Org Name:REVIVE COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:985-441-7550
Mailing Address - Street 1:302 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2646
Mailing Address - Country:US
Mailing Address - Phone:985-772-0879
Mailing Address - Fax:
Practice Address - Street 1:302 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2646
Practice Address - Country:US
Practice Address - Phone:985-772-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty