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General NPI Number Information
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NPI Number | 1528794914
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Entity Type | Organization
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Legal Business Name | REVISION COUNSELING AND WELLNESS, PLLC.
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 5960 FAIRVIEW RD STE 400
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City | CHARLOTTE
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State | NC
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Zip | 28210-3119
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Country | US
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Telephone | 704-649-7347
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1405
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City | PINEVILLE
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State | NC
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Zip | 28134-1405
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Country | US
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Telephone | 704-649-7347
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Fax |
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Authorized Official
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Title or Position | THERAPIST / CEO
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Name | MR. JARRETT L EVANS
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Credential | LCMHC
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Telephone | 704-649-7347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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