Provider Demographics
NPI:1932559911
Name:REVELS, JONATHAN (LCAS, CCS, NCC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:REVELS
Suffix:
Gender:M
Credentials:LCAS, CCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2891
Mailing Address - Country:US
Mailing Address - Phone:800-809-6989
Mailing Address - Fax:
Practice Address - Street 1:157 BROZZINI CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5340
Practice Address - Country:US
Practice Address - Phone:800-809-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22868101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)