| Revive Relationship Therapy | |
|
4300 Garden Vw Williamsburg VA 23188-7262 | |
| (717) 888-0173 | |
| Not Available |
| Full Name | Revive Relationship Therapy |
|---|---|
| Speciality | Counselor |
| Location | 4300 Garden Vw, Williamsburg, Virginia |
| Authorized Official Name and Position | Rosemary Via (OWNER) |
| Authorized Official Contact | 7178880173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Relationship Therapy 4300 Garden Vw Williamsburg VA 23188-7262 Ph: (717) 888-0173 | Revive Relationship Therapy 4300 Garden Vw Williamsburg VA 23188-7262 Ph: (717) 888-0173 |
| NPI Number | 1790296218 |
|---|---|
| Provider Enumeration Date | 10/24/2017 |
| Last Update Date | 02/22/2024 |
| Certification Date | 02/22/2024 |
| Medicare PECOS PAC ID | 7416394622 |
|---|---|
| Medicare Enrollment ID | O20240324000162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790296218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rosemary Elaine Via |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528367661 PECOS PAC ID: 8325485535 Enrollment ID: I20240324000164 |
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