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Organization
REVENTION RECOVERY SERVICES, LLC
Active
Organization
REVENTION RECOVERY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES M MISJA M.D. (PRESIDENT)
(937) 260-3156
Entity
Organization
Contact information
Practice address
8002 MCEWEN RD, CENTERVILLE, OH 45458-2033
(937) 681-9507
Mailing address
8002 MCEWEN RD, CENTERVILLE, OH 45458-2033
(937) 681-9507
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
05/01/2015
Last updated
05/01/2015
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