| Revival Counseling Services Incorporated | |
|
5357 Chapel Hill Rd Douglasville GA 30135-5027 | |
| (770) 942-4742 | |
| Not Available |
| Full Name | Revival Counseling Services Incorporated |
|---|---|
| Speciality | Social Worker |
| Location | 5357 Chapel Hill Rd, Douglasville, Georgia |
| Authorized Official Name and Position | Danielle Bonich (SOLE PROPRIETOR/OWNER) |
| Authorized Official Contact | 6786568249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Counseling Services Incorporated 4131 High Country Dr Douglasville GA 30135-4265 Ph: (678) 656-8249 | Revival Counseling Services Incorporated 5357 Chapel Hill Rd Douglasville GA 30135-5027 Ph: (770) 942-4742 |
| NPI Number | 1831647213 |
|---|---|
| Provider Enumeration Date | 09/14/2016 |
| Last Update Date | 09/14/2016 |
| Medicare PECOS PAC ID | 4284921818 |
|---|---|
| Medicare Enrollment ID | O20160927000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831647213 | NPI | - | NPPES |
| 4829878 | Other | GA | CIGNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Danielle R Bonich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427390590 PECOS PAC ID: 3274777339 Enrollment ID: I20130912000068 |
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