Provider Demographics
NPI:1174174601
Name:REVIS, JOE DOUGLAS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:DOUGLAS
Last Name:REVIS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:REVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:311 GENERAL GRIFFITH CIR
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-9273
Mailing Address - Country:US
Mailing Address - Phone:828-429-8620
Mailing Address - Fax:
Practice Address - Street 1:356 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2916
Practice Address - Country:US
Practice Address - Phone:828-287-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0060461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical