Provider Demographics
NPI:1992457774
Name:REVIERE, EMONIE LOLICE
Entity type:Individual
Prefix:
First Name:EMONIE
Middle Name:LOLICE
Last Name:REVIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 EASTCHESTER DR STE 202A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3505
Mailing Address - Country:US
Mailing Address - Phone:336-252-2711
Mailing Address - Fax:
Practice Address - Street 1:1912 EASTCHESTER DR STE 202A
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3505
Practice Address - Country:US
Practice Address - Phone:336-252-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19945101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor