Provider Demographics
NPI:1346886801
Name:REVOLUTION PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:REVOLUTION PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PACIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:864-417-9668
Mailing Address - Street 1:245 E BROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2896
Mailing Address - Country:US
Mailing Address - Phone:864-417-9668
Mailing Address - Fax:
Practice Address - Street 1:245 E BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2896
Practice Address - Country:US
Practice Address - Phone:864-417-9668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty