| Revitalize Llc | |
|
6149 Deltona Blvd Spring Hill FL 34606-1000 | |
| (352) 606-0323 | |
| Not Available |
| Full Name | Revitalize Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 6149 Deltona Blvd, Spring Hill, Florida |
| Authorized Official Name and Position | Dory Richards (OWNER) |
| Authorized Official Contact | 3526060323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Llc 6149 Deltona Blvd Spring Hill FL 34606-1000 Ph: (352) 606-0323 | Revitalize Llc 6149 Deltona Blvd Spring Hill FL 34606-1000 Ph: (352) 606-0323 |
| NPI Number | 1508649955 |
|---|---|
| Provider Enumeration Date | 08/17/2023 |
| Last Update Date | 08/17/2023 |
| Certification Date | 08/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508649955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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