Revitalize Counseling, PLLC

Key facts

NPI

1700544350

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Social Worker 1041C0700X

Legal business name

REVITALIZE COUNSELING, PLLC

Practice address

431 Waterville Rd
Realeigh, NC 27603

Phone

(919) 357-8832

Fax

(919) 336-5134

NPI assigned

Dec 1, 2021

Organization subpart

No

Authorized official

Name

Ashley Craft, LCSW NPI 1447727607

Title

Owner

Phone

(919) 357-8832

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

• Ashley Cutrell Craft, LCSW Clinical Social Worker · Garner, NC · NPI 1447727607
  NPD Authorized official CLINICAL

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 1, 2021.

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1700544350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 TIMBER DR E # 1033",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275296917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 WATERVILLE RD",
            "city": "REALEIGH",
            "state": "NC",
            "postal_code": "27603",
            "telephone_number": "919-357-8832",
            "fax_number": "919-336-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-11-17",
        "status": "A",
        "authorized_official_last_name": "CRAFT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-357-8832",
        "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": "LCSW",
            "identifier": "C012367",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447727607",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}