Revival Counseling Services Incorporated

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVIVAL COUNSELING SERVICES INCORPORATED

Practice address

5357 Chapel Hill Rd
Douglasville, GA 30135-5027

Phone

(770) 942-4742

NPI assigned

Sep 14, 2016

Last updated

Sep 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Danielle Bonich, LCSWNPI 1427390590

Title

Sole Proprietor/Owner

Phone

(678) 656-8249

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Danielle R Bonich, LCSW

  • Clinical Social Worker
  • Douglasville, GA
  • NPI 1427390590
  Medicare reassignment NPD Authorized official
• Christena Lynn Hurst, MFT

  • Marriage & Family Therapist
  • Hiram, GA
  • NPI 1245578061
  NPD (past)
• James Otis Montford Jr., COUNSELOR,PHD

  • Professional Counselor
  • Douglasville, GA
  • NPI 1700445475
  NPD (past)
• Ingrid A. Richardson, LPC

  • Professional Counselor
  • Douglasville, GA
  • NPI 1710282587
  NPD (past)
• David Shelton, LMFT

  • Marriage & Family Therapist
  • Smyrna, GA
  • NPI 1194543132
  NPD (past)

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1831647213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 HIGH COUNTRY DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301354265",
            "telephone_number": "678-656-8249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5357 CHAPEL HILL RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355027",
            "telephone_number": "770-942-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL COUNSELING SERVICES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "BONICH",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "SOLE PROPRIETOR/OWNER",
        "authorized_official_telephone_number": "678-656-8249",
        "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": "CIGNA",
            "identifier": "4829878",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charissa Reynolds-Jenkins, LCSW
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• Michael E. Richards, O.D.
• Peter S Richards, MD

• Clinical Social Worker in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.