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Organization
REVIVE 180 LLC
Active
Organization
REVIVE 180 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY L PASHIA LPC (PROFESSIONAL COUNSELOR/OWNER)
(573) 438-9800
Entity
Organization
Contact information
Practice address
10071 CRESCENT RD, POTOSI, MO 63664-2040
(573) 438-9800
(573) 240-9916
Mailing address
10071 CRESCENT RD, POTOSI, MO 63664-2040
(573) 438-9800
(573) 240-9916
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490084654
—
MO
Enumeration date
07/22/2022
Last updated
12/11/2022
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