04D2233754 CLIA NUMBER - REVIVAL COUNSELING CENTER

Laboratory Demographics

  • CLIA Code: 04D2233754
  • Facility Name: REVIVAL COUNSELING CENTER
  • Facility Address: 4600 E NETTLETON AVE
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 243-8650
  • Facility Type: Other - MENTAL HEALTH FACLITY
  • Facility Type: Waiver
  • Lab Director: MS. JENNIFER TARWATER
  • NPI Number: 1326713215
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2233754
LAB Type Other - MENTAL HEALTH FACLITY
Facility Name REVIVAL COUNSELING CENTER
Street 4600 E NETTLETON AVE
City JONESBORO
State AR
ZIP 72401
Phone 870 243-8650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2023
Certificate Expiration Date 8/24/2025
Facility Type Other - MENTAL HEALTH FACLITY
Lab Director MS. JENNIFER TARWATER

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This page was last updated on: 6/4/2025