Provider Demographics
NPI:1972512192
Name:REVELS, MONICA CHARLENE (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CHARLENE
Last Name:REVELS
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 CLOUDS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-517-3902
Mailing Address - Fax:803-349-4925
Practice Address - Street 1:1477 EBENEZER ROAD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-517-3902
Practice Address - Fax:803-349-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4263101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor