Healthcare Provider Details

I. General information

NPI: 1629853189
Provider Name (Legal Business Name): REVELARE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GLENWOOD AVE SE BLDG 200 STE 210
ATLANTA GA
30316-2195
US

IV. Provider business mailing address

750 GLENWOOD AVE SE BLDG 200 STE 210
ATLANTA GA
30316-2195
US

V. Phone/Fax

Practice location:
  • Phone: 888-341-0244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ARIANNA PAIGE CARBINO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 404-905-7786