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General NPI Number Information
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NPI Number | 1013109552
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Entity Type | Individual
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Provider Name | TERRI MARTIN REVELLE MA, LPA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 111 E. JEFFERSON ST.
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City | JACKSON
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State | NC
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Zip | 27845
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Country | US
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Telephone | 252-578-3918
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Fax | 252-534-1216
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Provider Business Mailing Address
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Address Line | 518 PINE TOPS RD
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City | MURFREESBORO
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State | NC
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Zip | 27855-9663
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Country | US
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Telephone | 252-578-3918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3749
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License Number State | NC
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