Provider Demographics
NPI:1194487868
Name:REVIZION COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:REVIZION COUNSELING SERVICES, PLLC
Other - Org Name:CHARLESCIE L GRAHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLESCIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:919-679-2246
Mailing Address - Street 1:364 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5437
Mailing Address - Country:US
Mailing Address - Phone:919-679-2246
Mailing Address - Fax:
Practice Address - Street 1:364 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5437
Practice Address - Country:US
Practice Address - Phone:919-679-2246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2268448OtherSECRETARY OF STATE ID #