| Revive Counseling And Coaching Llc | |
|
1016 John Sims Pkwy E Ste B Niceville FL 32578-2202 | |
| (989) 715-4404 | |
| Not Available |
| Full Name | Revive Counseling And Coaching Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1016 John Sims Pkwy E Ste B, Niceville, Florida |
| Authorized Official Name and Position | Ruby Lisa Hawkins-jack (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9897154404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Counseling And Coaching Llc 224 Hillside Dr Niceville FL 32578-2354 Ph: () - | Revive Counseling And Coaching Llc 1016 John Sims Pkwy E Ste B Niceville FL 32578-2202 Ph: (989) 715-4404 |
| NPI Number | 1437871845 |
|---|---|
| Provider Enumeration Date | 09/13/2022 |
| Last Update Date | 09/13/2022 |
| Certification Date | 09/13/2022 |
| Medicare PECOS PAC ID | 9032587803 |
|---|---|
| Medicare Enrollment ID | O20221129001108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437871845 | NPI | - | NPPES |
| 1619233566 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ruby Lisa Hawkins-jack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619233566 PECOS PAC ID: 5395134555 Enrollment ID: I20211110001533 |
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