Provider Demographics
NPI:1306515317
Name:REVIVE COUNSELING LLC
Entity type:Organization
Organization Name:REVIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-279-6324
Mailing Address - Street 1:399 NW 2ND AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3848
Mailing Address - Country:US
Mailing Address - Phone:561-843-2548
Mailing Address - Fax:
Practice Address - Street 1:399 NW 2ND AVE STE 214
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3848
Practice Address - Country:US
Practice Address - Phone:561-843-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVIVE COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty