Provider Demographics
NPI:1356702161
Name:REVELATION COUNSELING CENTER
Entity type:Organization
Organization Name:REVELATION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LEAD THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA'SHONDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:502-224-4478
Mailing Address - Street 1:1040 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2763
Mailing Address - Country:US
Mailing Address - Phone:502-224-4478
Mailing Address - Fax:
Practice Address - Street 1:1040 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2763
Practice Address - Country:US
Practice Address - Phone:502-224-4478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health