Revitalize Counseling Services LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00555800 Issued in NJ

Legal business name

REVITALIZE COUNSELING SERVICES LLC

Practice address

2401 Woodland Rd
Manchester, NJ 08759-6135

Phone

(848) 459-5943

NPI assigned

Jan 12, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dana M Gibilisco, MS, LPC, NCCNPI 1841950615

Title

Ceo

Phone

(848) 459-5943

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dana Marie Gibilisco, LPC

  • Professional Counselor
  • Shamong, NJ
  • NPI 1841950615
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515715200000",
    "number": "1184132094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 WOODLAND RD",
            "city": "MANCHESTER",
            "state": "NJ",
            "postal_code": "087596135",
            "telephone_number": "848-459-5943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 WOODLAND RD",
            "city": "MANCHESTER",
            "state": "NJ",
            "postal_code": "087596135",
            "telephone_number": "848-459-5943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-01-12",
        "status": "A",
        "authorized_official_last_name": "GIBILISCO",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "848-459-5943",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00555800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Manchester, NJ
• Providers in Manchester, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.