Provider Demographics
NPI:1881096949
Name:REVISIONS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:REVISIONS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-481-6644
Mailing Address - Street 1:105 CANTERBURY LN
Mailing Address - Street 2:#1996
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-0490
Mailing Address - Country:US
Mailing Address - Phone:630-481-6644
Mailing Address - Fax:630-708-7632
Practice Address - Street 1:190 LILY CACHE LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3415
Practice Address - Country:US
Practice Address - Phone:630-481-6644
Practice Address - Fax:630-708-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty