Provider Demographics
NPI:1750096947
Name:REVIES, JESSICA LACHELLE (RBT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LACHELLE
Last Name:REVIES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LACHELLE
Other - Last Name:WINDBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SABAL PALM LN APT 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1739
Mailing Address - Country:US
Mailing Address - Phone:757-323-2784
Mailing Address - Fax:
Practice Address - Street 1:400 SABAL PALM LN APT 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1739
Practice Address - Country:US
Practice Address - Phone:757-323-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-254721106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician