| Name: | Revive Counseling and Wellness Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Oct 2017 (7 years ago) |
| Entity Number: | 000-405-899 |
| Register Number: | 000405899 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 3001 47TH AVENUE EASTTUSCALOOSA, AL 35405 |
| Registered Office Street Address ZIP Code: | 35405 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699537944 | 2024-01-23 | 2024-01-23 | 1105 SOUTHVIEW LN STE 103-115, TUSCALOOSA, AL, 354056390, US | 2615 6TH ST STE 8, TUSCALOOSA, AL, 354011727, US | |||||||||||||
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| Phone | +1 205-246-1656 |
Authorized person
| Name | KRYSTLE WHITE |
| Role | OWNER, THERAPIST |
| Phone | 2052461656 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WHITE, KRYSTLE | Agent | 1708 MONTROSE DRIVETUSCALOOSA, AL 35405 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
