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Organization
REVIVAL THERAPEUTIC SERVICES LLC
Active
Organization
REVIVAL THERAPEUTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN HALL LISW (OWNER)
(513) 401-4038
Entity
Organization
Contact information
Practice address
2885 LINDALE MOUNT HOLLY RD, AMELIA, OH 45102-9707
(513) 401-4038
Mailing address
2885 LINDALE MOUNT HOLLY RD, AMELIA, OH 45102-9707
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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