Provider Demographics
NPI:1386405645
Name:ANGELA REVERCOMB LPC LLC
Entity type:Organization
Organization Name:ANGELA REVERCOMB LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVERCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-955-8617
Mailing Address - Street 1:7901 ANOKA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3305
Mailing Address - Country:US
Mailing Address - Phone:804-229-3172
Mailing Address - Fax:
Practice Address - Street 1:3111 NORTHSIDE AVE STE 375
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5441
Practice Address - Country:US
Practice Address - Phone:804-955-8617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty