NPI Code Detail JSON Logo

1528794914 NPI number — REVISION COUNSELING AND WELLNESS, PLLC.

NPI Number: 1528794914
Health Care Provider/Practitioner: REVISION COUNSELING AND WELLNESS, PLLC.

Information about “1528794914” NPI (REVISION COUNSELING AND WELLNESS, PLLC.) exists in 1528794914 in HTML format HTML  |  1528794914 in plain Text format TXT  |  1528794914 in PDF (Portable Document Format) PDF  |  1528794914 in an XML format XML  formats.

NPI Number : 1528794914 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528794914",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REVISION COUNSELING AND WELLNESS, PLLC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1405",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PINEVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28134-1405",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-649-7347",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5960 FAIRVIEW RD STE 400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28210-3119",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-649-7347",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/27/2022",
    "LastUpdateDate": "07/27/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVANS",
    "AuthorizedOfficialFirstName": "JARRETT",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "THERAPIST / CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCMHC",
    "AuthorizedOfficialTelephoneNumber": "704-649-7347",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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