Individual
TERRI MARTIN REVELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPA
Contact information
Practice address
111 E. JEFFERSON ST., JACKSON, NC 27845
(252) 578-3918
(252) 534-1216
Mailing address
518 PINE TOPS RD, MURFREESBORO, NC 27855-9663
(252) 578-3918
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3749
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157CH
BLUE CROSS BLUE SHIELD
NC
05
—
6107657
—
NC
Enumeration date
08/17/2007
Last updated
01/16/2015
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