Provider Demographics
NPI:1407631880
Name:REVEAL WELLNESS LLC
Entity Type:Organization
Organization Name:REVEAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:HULBIG
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-766-8374
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MONUMENT BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02553-0263
Mailing Address - Country:US
Mailing Address - Phone:774-766-8374
Mailing Address - Fax:
Practice Address - Street 1:7 OLD PLATE RD
Practice Address - Street 2:
Practice Address - City:WEST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02576-1236
Practice Address - Country:US
Practice Address - Phone:774-766-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty