Healthcare Provider Details

I. General information

NPI: 1770126310
Provider Name (Legal Business Name): DEANNA REVELS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 DETROIT AVE STE 110
LAKEWOOD OH
44107-4210
US

IV. Provider business mailing address

14650 DETROIT AVE STE 110
LAKEWOOD OH
44107-4210
US

V. Phone/Fax

Practice location:
  • Phone: 216-238-3622
  • Fax:
Mailing address:
  • Phone: 216-238-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203123-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: