Provider Demographics
NPI:1528794914
Name:REVISION COUNSELING AND WELLNESS, PLLC.
Entity type:Organization
Organization Name:REVISION COUNSELING AND WELLNESS, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-649-7347
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-1405
Mailing Address - Country:US
Mailing Address - Phone:704-649-7347
Mailing Address - Fax:
Practice Address - Street 1:5960 FAIRVIEW RD STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3119
Practice Address - Country:US
Practice Address - Phone:704-649-7347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty