| Revere Counseling And Care Management Llc | |
|
235 E Ponce De Leon Ave Ste 330 Decatur GA 30030-3452 | |
| (404) 281-5422 | |
| Not Available |
| Full Name | Revere Counseling And Care Management Llc |
|---|---|
| Speciality | Social Worker |
| Location | 235 E Ponce De Leon Ave Ste 330, Decatur, Georgia |
| Authorized Official Name and Position | Stephanie Lynn Roach (OWNER) |
| Authorized Official Contact | 4047363793 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revere Counseling And Care Management Llc 235 E Ponce De Leon Ave Ste 330 Decatur GA 30030-3452 Ph: (404) 281-5422 | Revere Counseling And Care Management Llc 235 E Ponce De Leon Ave Ste 330 Decatur GA 30030-3452 Ph: (404) 281-5422 |
| NPI Number | 1114429412 |
|---|---|
| Provider Enumeration Date | 03/02/2018 |
| Last Update Date | 07/19/2022 |
| Certification Date | 07/19/2022 |
| Medicare PECOS PAC ID | 3577811520 |
|---|---|
| Medicare Enrollment ID | O20180807003302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114429412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | CSW002619 (Georgia) | Primary |
| Provider Name | Stephanie L Roach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689182263 PECOS PAC ID: 5890043855 Enrollment ID: I20180808001531 |
| Provider Name | Kelly C Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922564988 PECOS PAC ID: 6901132539 Enrollment ID: I20190719001395 |
| Provider Name | Malika A. Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235751801 PECOS PAC ID: 0840613329 Enrollment ID: I20200701001507 |
| Provider Name | Eve Elizabeth Mcclennen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689276305 PECOS PAC ID: 4284046103 Enrollment ID: I20201218000394 |
| Provider Name | Rae Sirott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376265108 PECOS PAC ID: 4587602602 Enrollment ID: I20221020001479 |
| Provider Name | Caroline Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114483898 PECOS PAC ID: 7719396506 Enrollment ID: I20230314000212 |
| Provider Name | Sarah Hamm Spencer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407449713 PECOS PAC ID: 0941655492 Enrollment ID: I20231018002280 |
| Provider Name | Grace Kim |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477218212 PECOS PAC ID: 4789020488 Enrollment ID: I20240315000873 |
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