Provider Demographics
NPI:1508613282
Name:REVIVING WELLNESS AND MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:REVIVING WELLNESS AND MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-424-4886
Mailing Address - Street 1:1109 GUM BRANCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5742
Mailing Address - Country:US
Mailing Address - Phone:252-424-4886
Mailing Address - Fax:
Practice Address - Street 1:1109 GUM BRANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5742
Practice Address - Country:US
Practice Address - Phone:252-424-4886
Practice Address - Fax:252-417-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty