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Organization

REVITALIZE MINDS COUNSELING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TANGELLA MICHELLE FOREMAN LCSW (THERAPIST)
(870) 926-7344
Entity
Organization

Contact information

Practice address
312 N MISSOURI ST STE 1, WEST MEMPHIS, AR 72301-3186
(870) 796-8997
(870) 796-8998
Mailing address
312 N MISSOURI ST, WEST MEMPHIS, AR 72301-3142
(870) 796-8997
(870) 796-8998

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
07/29/2022
Last updated
01/16/2023
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