Organization
REVOLUTIONARY WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A MARGRAVES LCSW (MANAGING PARTNER)
(512) 569-4017
Entity
Organization
Contact information
Practice address
213 SINUSO DR, GEORGETOWN, TX 78628-1533
(512) 569-4017
Mailing address
213 SINUSO DR, GEORGETOWN, TX 78628-1533
(512) 569-4017
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/04/2017
Last updated
11/10/2025
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