Healthcare Provider Details

I. General information

NPI: 1689202012
Provider Name (Legal Business Name): INNOVATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INNOVATIVE CARE LLC 5712 OAK KNOLL RD.
MIDLOTHIAN VA
23112-2400
US

IV. Provider business mailing address

INNOVATIVE CARE LLC 5712 OAK KNOLL RD.
MIDLOTHIAN VA
23112-2400
US

V. Phone/Fax

Practice location:
  • Phone: 804-608-6577
  • Fax: 855-700-5593
Mailing address:
  • Phone: 804-608-9704
  • Fax: 855-700-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN BENSON RICHARDSON
Title or Position: OWNER/CEO
Credential: LCSW
Phone: 804-608-9704