Provider Demographics
NPI:1548248495
Name:NESBIT, REVELLA H (LCMHCS)
Entity type:Individual
Prefix:MRS
First Name:REVELLA
Middle Name:H
Last Name:NESBIT
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 AMBER LEIGH WAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-399-8402
Mailing Address - Fax:704-392-3586
Practice Address - Street 1:9625 DAVID TAYLOR DRIVE, SUITE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-399-8402
Practice Address - Fax:704-392-3586
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102253Medicaid