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Organization
REVIVE THERAPEUTIC SERVICES
Active
Organization
REVIVE THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEANDRA SALLEY MSW (PARTNER)
(252) 762-9788
Entity
Organization
Contact information
Practice address
2205 WOODLEAF RD APT 7H, SALISBURY, NC 28147-1181
(252) 762-9788
Mailing address
2205 WOODLEAF RD APT 7H, SALISBURY, NC 28147-1181
(252) 762-9788
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
01/25/2019
Last updated
01/25/2019
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