NPIMap

Organization Active NPI

Revive Counseling and Wellness Services, LLC

  • Professional Counselor
  • Egg Harbor TWP, NJ
National Provider Identifier
1740948827
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
REVIVE COUNSELING AND WELLNESS SERVICES, LLC
Practice address
102 Jefferson Ave
Egg Harbor TWP, NJ 08234-9739
Phone
(609) 402-6920
NPI assigned
Dec 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Authorized official

Name
Dr. Veronica L. Ford, PH.D., LPCNPI 1841832268
Title
Co-Owner
Phone
(609) 402-6920

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

102 Jefferson Ave
Egg Harbor TWP, NJ 08234-9739

Mailing address

PO Box 1536
Pleasantville, NJ 08232-6536
Phone (609) 402-6920

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1740948827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1536",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082326536",
            "telephone_number": "609-402-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 JEFFERSON AVE",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082349739",
            "telephone_number": "609-402-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE COUNSELING AND WELLNESS SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "609-402-6920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Egg Harbor TWP, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.