# REVOLUTIONARY WELLNESS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609311455
- **Authorized official:** LISA A MARGRAVES LCSW (MANAGING PARTNER)
- **Authorized official phone:** (512) 569-4017

## Contact information

- **Practice address:** 213 SINUSO DR, GEORGETOWN, TX 78628-1533
- **Practice address phone:** (512) 569-4017
- **Mailing address:** 213 SINUSO DR, GEORGETOWN, TX 78628-1533
- **Mailing address phone:** (512) 569-4017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/04/2017
- **Last updated:** 11/10/2025