Revive Counseling and Coaching LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVIVE COUNSELING AND COACHING LLC

Practice address

1016 John Sims Pkwy E Ste B
Niceville, FL 32578-2202

Phone

(989) 715-4404

NPI assigned

Sep 13, 2022

Organization subpart

No

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

Authorized official

Name

Ruby Lisa Hawkins-Jack, LCSWNPI 1619233566

Title

Licensed Clinical Social Worker

Phone

(989) 715-4404

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Ruby Lisa Hawkins-Jack, LCSW

  • Clinical Social Worker
  • Niceville, FL
  • NPI 1619233566
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1437871845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 HILLSIDE DR",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325782354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 JOHN SIMS PKWY E STE B",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325782202",
            "telephone_number": "989-715-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE COUNSELING AND COACHING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "HAWKINS-JACK",
        "authorized_official_first_name": "RUBY",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "989-715-4404",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1619233566",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "revive@itherapymail.com",
            "affiliation": "N",
            "endpointDescription": "secure software program",
            "address_1": "1016 John Sims Pkwy E Ste B",
            "city": "Niceville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325782202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shannon Raychel
• Callie Reader
• Alexandra Reed, RBT
• Rachel Maria Reid, PA-C
• Jasmine Revercomb
• Ashley Elizabeth Reynolds, M.D.
• Michelle Rhoads
• Lucy K Rice, MD
• Tiffany Richard-McLaughlin
• Angela Rickett

• Clinical Social Worker in Niceville, FL
• Providers in Niceville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.