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Organization

REVIVICATION COUNSELING SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LEVITICUS LOFTON LCSW (CEO)
(757) 447-0102
Entity
Organization

Contact information

Practice address
321 N MAIN ST SUITE C, SUFFOLK, VA 23434-4422
(727) 477-0102
(757) 477-0142
Mailing address
PO BOX 1211, SUFFOLK, VA 23439
(757) 477-0102
(757) 477-0142

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
1041C0700X
Clinical Social Worker
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
04/26/2019
Last updated
03/21/2022
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