Provider Demographics
NPI:1962193441
Name:REVIVE WELLNESS COUNSELING CENTER
Entity type:Organization
Organization Name:REVIVE WELLNESS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIONI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-709-1612
Mailing Address - Street 1:1936 SELBY AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6785
Mailing Address - Country:US
Mailing Address - Phone:310-709-1612
Mailing Address - Fax:
Practice Address - Street 1:1936 SELBY AVE APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6785
Practice Address - Country:US
Practice Address - Phone:310-709-1612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty