Provider Demographics
NPI:1457185761
Name:REVELS, WHITNEY DANIELLE (LCSW-A)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DANIELLE
Last Name:REVELS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 MT OLIVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-8251
Mailing Address - Country:US
Mailing Address - Phone:910-374-4514
Mailing Address - Fax:
Practice Address - Street 1:2300 N PINE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3942
Practice Address - Country:US
Practice Address - Phone:910-501-6366
Practice Address - Fax:910-370-7352
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0211431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical