Organization
REVITALIZED WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMEKA LIPSCOMB (OWNER)
(972) 838-0652
Entity
Organization
Contact information
Practice address
1043 MEADOW RUN DR, DUNCANVILLE, TX 75137-3599
(972) 838-0652
Mailing address
539 W COMMERCE ST # 4182, DALLAS, TX 75208-1953
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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