Provider Demographics
NPI:1780142554
Name:REVIVING EMOTIONAL STRENGTH, LLC
Entity type:Organization
Organization Name:REVIVING EMOTIONAL STRENGTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-524-4688
Mailing Address - Street 1:1275 OPIE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2737
Mailing Address - Country:US
Mailing Address - Phone:678-524-4688
Mailing Address - Fax:
Practice Address - Street 1:2775 CRUSE RD STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7141
Practice Address - Country:US
Practice Address - Phone:678-524-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)