Healthcare Provider Details

I. General information

NPI: 1225856008
Provider Name (Legal Business Name): AEVUM BH VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 FOREST HILL AVE
RICHMOND VA
23225-3241
US

IV. Provider business mailing address

440 SYLVAN AVE STE 240
ENGLEWOOD CLIFFS NJ
07632-2700
US

V. Phone/Fax

Practice location:
  • Phone: 848-210-0028
  • Fax:
Mailing address:
  • Phone: 804-446-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LEVI LIPOVENKO
Title or Position: CEO
Credential: PSYD
Phone: 804-446-1710