Revive Therapy, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

REVIVE THERAPY, LLC

Practice address

104 Maxwell Ave Ste 208
Greenwood, SC 29646-2641

Phone

(864) 495-3131

Fax

(864) 495-3132

NPI assigned

Feb 18, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Nina Grace Singh, LPCNPI 1699261743

Title

Licensed Professional Counselors

Phone

(864) 323-6414

Specialties & licenses 1

Addresses

Other names 1

• Bloom Therapy, LLC Former legal business name

Locations

Practitioners 1

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

• Nina G Singh

  • Professional Counselor
  • Greenwood, SC
  • NPI 1699261743
  NPD Authorized official

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1427641596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MAXWELL AVE STE 208",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462641",
            "telephone_number": "864-495-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MAXWELL AVE STE 208",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462641",
            "telephone_number": "864-495-3131",
            "fax_number": "864-495-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "NINA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELORS",
        "authorized_official_telephone_number": "864-323-6414",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Therapy, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Professional Counselor in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.