Provider Demographics
NPI:1972379196
Name:REVIVE THEN THRIVE MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:REVIVE THEN THRIVE MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:REVIVE THEN THRIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ CFO / SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALLELUJAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-471-3474
Mailing Address - Street 1:785 QUINTANA RD # 618
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1943
Mailing Address - Country:US
Mailing Address - Phone:805-316-1341
Mailing Address - Fax:
Practice Address - Street 1:501 MORRO BAY BLVD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442
Practice Address - Country:US
Practice Address - Phone:805-316-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty