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Organization
REVITALIFE THERAPY & COUNSELING LLC
Active
Organization
REVITALIFE THERAPY & COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBBY WARD (OWNER)
(252) 231-2668
Entity
Organization
Contact information
Practice address
1101 EXECUTIVE BLVD STE B, CHESAPEAKE, VA 23320-3634
(252) 231-2668
(252) 377-4231
Mailing address
212 BILLETTS BRIDGE RD, CAMDEN, NC 27921-7505
(252) 231-2668
(252) 377-4231
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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