| Revive 3.23, Llc | |
|
200 Beacon Pkwy W Ste 101 Birmingham AL 35209-3102 | |
| (205) 215-4211 | |
| Not Available |
| Full Name | Revive 3.23, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 200 Beacon Pkwy W Ste 101, Birmingham, Alabama |
| Authorized Official Name and Position | Joi Iman Gresham (OWNER) |
| Authorized Official Contact | 2052154211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive 3.23, Llc 301 8th Pl Pleasant Grove AL 35127-1829 Ph: (205) 215-4211 | Revive 3.23, Llc 200 Beacon Pkwy W Ste 101 Birmingham AL 35209-3102 Ph: (205) 215-4211 |
| NPI Number | 1821778788 |
|---|---|
| Provider Enumeration Date | 07/24/2023 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821778788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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