| Angela Revercomb Lpc Llc | |
|
3111 Northside Ave Ste 375 Henrico VA 23228-5441 | |
| (804) 955-8617 | |
| Not Available |
| Full Name | Angela Revercomb Lpc Llc |
|---|---|
| Speciality | Counselor |
| Location | 3111 Northside Ave Ste 375, Henrico, Virginia |
| Authorized Official Name and Position | Angela Revercomb (OWNER/PROVIDER) |
| Authorized Official Contact | 8049558617 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Revercomb Lpc Llc 7901 Anoka Rd Richmond VA 23229-3305 Ph: (804) 229-3172 | Angela Revercomb Lpc Llc 3111 Northside Ave Ste 375 Henrico VA 23228-5441 Ph: (804) 955-8617 |
| NPI Number | 1386405645 |
|---|---|
| Provider Enumeration Date | 01/23/2024 |
| Last Update Date | 01/23/2024 |
| Certification Date | 01/23/2024 |
| Medicare PECOS PAC ID | 1951747880 |
|---|---|
| Medicare Enrollment ID | O20240313002669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386405645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Angela L Revercomb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700057825 PECOS PAC ID: 5597101428 Enrollment ID: I20240313002731 |
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