Healthcare Provider Details

I. General information

NPI: 1376475244
Provider Name (Legal Business Name): TONDA D REVELS CTSS, CANS CERTIFIED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PARK ST
ATHENS TN
37303-4255
US

IV. Provider business mailing address

111 PARK ST
ATHENS TN
37303-4255
US

V. Phone/Fax

Practice location:
  • Phone: 423-252-0075
  • Fax:
Mailing address:
  • Phone: 423-252-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: