Provider Demographics
NPI:1821717919
Name:LOCKE, REVATI ALICE
Entity Type:Individual
Prefix:MS
First Name:REVATI
Middle Name:ALICE
Last Name:LOCKE
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 1:31 HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1315
Mailing Address - Country:US
Mailing Address - Phone:504-418-2743
Mailing Address - Fax:
Practice Address - Street 1:200 SWANNANOA RIVER RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2216
Practice Address - Country:US
Practice Address - Phone:828-470-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician