Organization
MIND REVIVAL PSYCH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EBONIE WILLIAMS NP (NP/OWNER)
(708) 715-2035
Entity
Organization
Contact information
Practice address
7201 S STONY ISLAND AVE # 7, CHICAGO, IL 60649-2806
(773) 690-5300
(870) 201-4835
Mailing address
7201 S STONY ISLAND AVE # 7, CHICAGO, IL 60649-2806
(773) 690-5300
(870) 201-4835
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/18/2025
Last updated
12/12/2025
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