Organization
REVIVE WELLCO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SCHALOW LPC-S (CEO)
(501) 318-3760
Entity
Organization
Contact information
Practice address
518 LATHAM CT., CLARKSVILLE, TN 37043
(501) 318-3760
Mailing address
919 TINY TOWN RD, SUITE B #2021, CLARKSVILLE, TN 37042-7660
(501) 318-3760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
10/18/2024
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