ALYSSA REVUELTA


Address: 10 Resolute Ln, Suite 207, Mt Pleasant, SC 29464-6608
Phone: 8438109682

ALYSSA REVUELTA (NPI# 1871780213) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1871780213
Entity Type Individual
Full Name ALYSSA REVUELTA
Credential PH.D.
Practice Address 10 Resolute Ln
Suite 207
Mt Pleasant
SC 29464-6608
Practice Telephone 8438109682
Practice Fax Number 8434084478
Mailing Telephone 8438109682
Mailing Fax Number 8434084478
Enumeration Date 2007-10-01
Last Update Date 2012-11-13
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC2200X Psychologist
Specialization: Clinical Child & Adolescent
1184 SC Behavioral Health & Social Service Providers

Office Location

Street Address 10 RESOLUTE LN
SUITE 207
City MT PLEASANT
State SC
Zip Code 29464-6608

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Taxonomy Information

Taxonomy Code 103TC2200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical Child & Adolescent

Taxonomy Definition

Definition to come...
Notes: [1/1/2007: title modified]

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1053927004 Kathryn L Marsh Psychologist 1505 Blanding St, Columbia, SC 29201-2906 2020-09-16
1649671413 Rebecca J Cavazos Morrow Psychologist 403 Stony Landing Rd, Moncks Corner, SC 29461-3967 2014-09-11
1629490701 Kristina Kania Bates Psychologist 200 Patewood Dr, Suite A200, Greenville, SC 29615-3593 2014-01-09
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Competitor

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City MT PLEASANT
Zip Code 29464

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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