| Revive Counseling | |
|
9238 Madison Blvd Ste 116 Madison AL 35758-9112 | |
| (920) 948-4535 | |
| (256) 542-3289 |
| Full Name | Revive Counseling |
|---|---|
| Speciality | Clinic/Center |
| Location | 9238 Madison Blvd Ste 116, Madison, Alabama |
| Authorized Official Name and Position | Amber Dallman (THERAPIST/OWNER) |
| Authorized Official Contact | 9209484535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Counseling 9238 Madison Blvd Ste 116 Madison AL 35758-9112 Ph: (920) 948-4535 | Revive Counseling 9238 Madison Blvd Ste 116 Madison AL 35758-9112 Ph: (920) 948-4535 |
| NPI Number | 1063082840 |
|---|---|
| Provider Enumeration Date | 06/25/2021 |
| Last Update Date | 06/25/2021 |
| Certification Date | 06/25/2021 |
| Medicare PECOS PAC ID | 2961809850 |
|---|---|
| Medicare Enrollment ID | O20210920001974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063082840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amber Rose Dallman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255790945 PECOS PAC ID: 1052600079 Enrollment ID: I20160516000462 |
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