Organization
REVIVAL COUNSELING SERVICES INCORPORATED
Active
Organization
REVIVAL COUNSELING SERVICES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE BONICH LCSW (SOLE PROPRIETOR/OWNER)
(678) 656-8249
Entity
Organization
Contact information
Practice address
5357 CHAPEL HILL RD, DOUGLASVILLE, GA 30135-5027
(770) 942-4742
Mailing address
4131 HIGH COUNTRY DR, DOUGLASVILLE, GA 30135-4265
(678) 656-8249
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4829878
CIGNA
GA
Enumeration date
09/14/2016
Last updated
09/14/2016
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