Healthcare Provider Details

I. General information

NPI: 1194487868
Provider Name (Legal Business Name): REVIZION COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 SOMERSET DR
RAEFORD NC
28376-5437
US

IV. Provider business mailing address

364 SOMERSET DR
RAEFORD NC
28376-5437
US

V. Phone/Fax

Practice location:
  • Phone: 919-679-2246
  • Fax:
Mailing address:
  • Phone: 919-679-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLESCIE LEE GRAHAM
Title or Position: CLINICIAN/OWNER
Credential: LCSW, LCAS
Phone: 919-679-2246