Organization
REVIVE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREEANA KENNEDY LCMHC (CLINICAL COUNSELOR)
(910) 271-0415
Entity
Organization
Contact information
Practice address
226 N FRONT ST # 118, WILMINGTON, NC 28401-3920
(910) 518-9837
Mailing address
103 ARABIAN CIR, BEULAVILLE, NC 28518-6791
(910) 271-0415
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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