Organization
REVIVE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEIZA STANLEY LCSW (OWNER)
(640) 457-8542
Entity
Organization
Contact information
Practice address
119 HARRY ST, FIRST FLOOR, CONSHOHOCKEN, PA 19428
(610) 457-8542
Mailing address
119 HARRY STREET, CONSHOHOCKEN, PA 19428
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CW016642
PA
Other
Enumeration date
01/12/2017
Last updated
05/04/2017
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