Organization
REVIVE COUNSELING PROFESSIONALS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY JASON RAY LISW-CP (MENTAL HEALTH PRACTITIONER)
(864) 832-2296
Entity
Organization
Contact information
Practice address
202 SANDY SHORES DR, TOWNVILLE, SC 29689-4247
(864) 832-2296
Mailing address
202 SANDY SHORES DR, TOWNVILLE, SC 29689-4247
(864) 832-2296
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/30/2024
Last updated
04/30/2024
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