Revamp & Prevail Therapy, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REVAMP & PREVAIL THERAPY, PLLC

Practice address

1213 W Morehead St Ste 500
Charlotte, NC 28208-5581

Phone

(704) 737-8242

NPI assigned

Apr 7, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Bruno, LCMHC

Title

President

Phone

(704) 737-8242

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1295314136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 W MOREHEAD ST STE 500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085581",
            "telephone_number": "704-737-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 W MOREHEAD ST STE 500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085581",
            "telephone_number": "704-737-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAMP & PREVAIL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "BRUNO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-737-8242",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.