Revitalife Therapy & Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVITALIFE THERAPY & COUNSELING LLC

Practice address

1101 Executive Blvd Ste B
Chesapeake, VA 23320-3634

Phone

(252) 231-2668

Fax

(252) 377-4231

NPI assigned

Jan 22, 2020

Organization subpart

No

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

Authorized official

Name

Robby Ward

Title

Owner

Phone

(252) 231-2668

Specialties & licenses 4

Addresses

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: robby@hpcbilling.com

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1811527500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 BILLETTS BRIDGE RD",
            "city": "CAMDEN",
            "state": "NC",
            "postal_code": "279217505",
            "telephone_number": "252-231-2668",
            "fax_number": "252-377-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 EXECUTIVE BLVD STE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203634",
            "telephone_number": "252-231-2668",
            "fax_number": "252-377-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIFE THERAPY & COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROBBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-231-2668"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Robby@hpcbilling.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1101 Executive Blvd Ste B",
            "city": "Chesapeake",
            "state": "VA",
            "country_code": "US",
            "postal_code": "233203634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Chesapeake, VA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.