| Revive Therapeutic Counseling Services | |
|
10810 Winchester St Apt 105 Waldorf MD 20603-7218 | |
| (301) 276-1151 | |
| (443) 440-5682 |
| Full Name | Revive Therapeutic Counseling Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 10810 Winchester St Apt 105, Waldorf, Maryland |
| Authorized Official Name and Position | Camille A Lewis (OWNER) |
| Authorized Official Contact | 3012761151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Therapeutic Counseling Services 10810 Winchester St Apt 105 Waldorf MD 20603-7218 Ph: (301) 276-1151 | Revive Therapeutic Counseling Services 10810 Winchester St Apt 105 Waldorf MD 20603-7218 Ph: (301) 276-1151 |
| NPI Number | 1609503192 |
|---|---|
| Provider Enumeration Date | 08/04/2022 |
| Last Update Date | 05/16/2025 |
| Certification Date | 05/15/2025 |
| Medicare PECOS PAC ID | 7214452549 |
|---|---|
| Medicare Enrollment ID | O20250421000269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609503192 | NPI | - | NPPES |
| 999013500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Camille A Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912357245 PECOS PAC ID: 4789104894 Enrollment ID: I20250219003354 |
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