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Organization
REVIVAL THERAPY, P.C.
Active
Organization
REVIVAL THERAPY, P.C.
Active
Other names
Revival Therapy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARA LEMKE LCPC, CADC (CEO/PRACTICE OWNER)
(815) 451-6585
Entity
Organization
Contact information
Practice address
330 W. TERRA COTTA AVE., SUITE A, CRYSTAL LAKE, IL 60014
(815) 382-9691
(815) 800-0670
Mailing address
330 W. TERRA COTTA AVE., SUITE A, CRYSTAL LAKE, IL 60014
(815) 382-9691
(815) 800-0670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
09/29/2020
Last updated
08/09/2024
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