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NPI Code Detail

MEDICARE: INNOVATIVE CARE LLC

MEDICARE: INNOVATIVE CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
41041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689202012
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE CARE LLC
Provider Business Mailing Address
First Line : INNOVATIVE CARE LLC
Second Line : 5712 OAK KNOLL RD.
City : MIDLOTHIAN
State : VA
Zip : 23112-2400
Country : US
Telephone Number : 804-608-9704
Fax Number : 855-700-5593
Provider Business Practice Location Address
First Line : INNOVATIVE CARE LLC
Second Line : 5712 OAK KNOLL RD.
City : MIDLOTHIAN
State : VA
Zip : 23112-2400
Country : US
Telephone Number : 804-608-6577
Fax Number : 855-700-5593
Authorized Official
Title or Position : OWNER/CEO
Name : AUTUMN BENSON RICHARDSON
Credential : LCSW
Telephone Number : 804-608-9704
Provider Enumeration Date : 03/31/2020
Last Update Date : 02/26/2026

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Directions to “INNOVATIVE CARE LLC ” Practice Location

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